Provider Demographics
NPI:1417231085
Name:VIDRINE, ASHLEY BROOKE (PT)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:BROOKE
Last Name:VIDRINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 N ROLLING ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-744-1666
Mailing Address - Fax:410-788-9755
Practice Address - Street 1:516 N ROLLING ROAD
Practice Address - Street 2:SUITE 302
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-744-1666
Practice Address - Fax:410-788-9755
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23814225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist