Provider Demographics
NPI:1194979880
Name:ASHTON, MARYALICE LAMANNA (DPT)
Entity type:Individual
Prefix:
First Name:MARYALICE
Middle Name:LAMANNA
Last Name:ASHTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 LOCKHART ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-1205
Mailing Address - Country:US
Mailing Address - Phone:732-232-2894
Mailing Address - Fax:
Practice Address - Street 1:1733 LOCKHART ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-1205
Practice Address - Country:US
Practice Address - Phone:732-232-2894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-08
Last Update Date:2008-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00787200172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker