Provider Demographics
NPI:1386460285
Name:MYERS, ASHLEY ELISHA (ATC)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ELISHA
Last Name:MYERS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ELISHA
Other - Last Name:SURMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:45 REID HOLLOW LN APT H
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-7986
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 REID HOLLOW LN APT H
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-7986
Practice Address - Country:US
Practice Address - Phone:414-217-8890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3198712255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer