Provider Demographics
NPI:1033474432
Name:SHUPE, ASHLEE MARIE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEE
Middle Name:MARIE
Last Name:SHUPE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:ASHLEE
Other - Middle Name:MARIE
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:390 LINCOLN ST STE 230
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6021
Mailing Address - Country:US
Mailing Address - Phone:541-255-2095
Mailing Address - Fax:541-255-2445
Practice Address - Street 1:390 LINCOLN ST STE 230
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6021
Practice Address - Country:US
Practice Address - Phone:541-255-2095
Practice Address - Fax:541-255-2445
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9855PT208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ12409672OtherCAQH
AZZ154526Medicare PIN