Provider Demographics
NPI:1174299341
Name:FARIS, ASHLEY KATHLEEN (PT, DPT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KATHLEEN
Last Name:FARIS
Suffix:
Gender:F
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 JUNCTION DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5290
Mailing Address - Country:US
Mailing Address - Phone:469-675-3153
Mailing Address - Fax:
Practice Address - Street 1:900 JUNCTION DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5290
Practice Address - Country:US
Practice Address - Phone:469-675-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11952225100000X
TX1350248225100000X
2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist