Individual
ASHLEY P THEOBALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11111 PANAMA CITY BEACH PKWY, PANAMA CITY BEACH, FL 32407-2448
(850) 804-2900
Mailing address
1601 CUMMINS DR STE D, MODESTO, CA 95358-6411
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
10184
TN
363A00000X
Physician Assistant
4280
SC
363A00000X
Physician Assistant
Primary
PA9121510
FL
Other
Enumeration date
09/24/2014
Last updated
07/31/2026
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