Provider Demographics
NPI:1992335509
Name:PICKLE, ASHTON (DPT)
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:PICKLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LOMA LN
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4721
Mailing Address - Country:US
Mailing Address - Phone:863-430-5389
Mailing Address - Fax:
Practice Address - Street 1:150 LOMA LN
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4721
Practice Address - Country:US
Practice Address - Phone:863-430-5389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports