Provider Demographics
NPI:1083907117
Name:MILLIKAN, ASHLEY KRISTEN (PTA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KRISTEN
Last Name:MILLIKAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 E PALM LN UNIT 121
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-3129
Mailing Address - Country:US
Mailing Address - Phone:602-689-0486
Mailing Address - Fax:
Practice Address - Street 1:2852 N NAVAJO DR STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-4966
Practice Address - Country:US
Practice Address - Phone:928-772-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8834A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant