Provider Demographics
NPI:1124583026
Name:GREENWOOD, ASHLEY (LAT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20326 S GRAND PRAIRIE LN
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-8784
Mailing Address - Country:US
Mailing Address - Phone:815-922-6493
Mailing Address - Fax:
Practice Address - Street 1:2001 ALFORD PARK DR
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-1994
Practice Address - Country:US
Practice Address - Phone:815-922-6493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer