Individual
DR. ASHLEY MICHELE TANKERSLEY FAIRCLOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.T.
Contact information
Practice address
1796 W CAUSEWAY APPROACH, MANDEVILLE, LA 70471-2955
(985) 626-1671
(985) 624-4984
Mailing address
318 NOTTOWAY DR, PEARL RIVER, LA 70452-3804
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
08611
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08611
LICENSE TO PRACTICE PHYSICAL THERAPY
LA
Enumeration date
12/11/2013
Last updated
12/11/2013
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