Provider Demographics
NPI:1437687613
Name:VITARELLI, ASHLEY SIMPSON (DPT)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:SIMPSON
Last Name:VITARELLI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:SIMPSON
Other - Last Name:VITARELLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92662-1007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24361 EL TORO RD STE 140
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2755
Practice Address - Country:US
Practice Address - Phone:949-715-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist