Provider Demographics
NPI:1205833100
Name:KIXMILLER, ASHEN
Entity Type:Individual
Prefix:MR
First Name:ASHEN
Middle Name:
Last Name:KIXMILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1634
Mailing Address - Country:US
Mailing Address - Phone:765-362-6740
Mailing Address - Fax:765-362-6750
Practice Address - Street 1:402 W MARKET ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1634
Practice Address - Country:US
Practice Address - Phone:765-362-6740
Practice Address - Fax:765-362-6750
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002760A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN06002760AOtherPHY. THER. ASS'T LICENSE