Provider Demographics
NPI:1164778718
Name:FAUTH, ASHLEY D (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:D
Last Name:FAUTH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:D
Other - Last Name:WESTERLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3048 MOMENTUM PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5330
Mailing Address - Country:US
Mailing Address - Phone:262-657-0222
Mailing Address - Fax:262-657-7190
Practice Address - Street 1:237 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TWIN LAKES
Practice Address - State:WI
Practice Address - Zip Code:53181-9681
Practice Address - Country:US
Practice Address - Phone:262-877-4884
Practice Address - Fax:262-877-4629
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11995-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI859400079OtherMEDICARE
WIP01113279OtherRAILROAD MEDICARE