Provider Demographics
NPI:1235755240
Name:MCCOLLOUGH, ASHLEY M (PT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:MCCOLLOUGH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:MCGARITY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 80964
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-0964
Mailing Address - Country:US
Mailing Address - Phone:337-233-7977
Mailing Address - Fax:
Practice Address - Street 1:9462 ELLERBE RD STE 200
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7446
Practice Address - Country:US
Practice Address - Phone:318-606-5262
Practice Address - Fax:318-606-5351
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07502225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA07502OtherPHYSICAL THERAPY LICENSE