Provider Demographics
NPI:1073296646
Name:NIMMO, ASHLEY M (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:NIMMO
Suffix:
Gender:F
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:PO BOX 219297
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9297
Mailing Address - Country:US
Mailing Address - Phone:417-753-7735
Mailing Address - Fax:
Practice Address - Street 1:113 JOHNSTOWN DR
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65742-9366
Practice Address - Country:US
Practice Address - Phone:417-753-7735
Practice Address - Fax:417-753-7765
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023039751225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist