Provider Demographics
NPI:1275276727
Name:MCNUTT, ASHLEIGH MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:MARIE
Last Name:MCNUTT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 BLARNEY DR
Mailing Address - Street 2:
Mailing Address - City:WEAVER
Mailing Address - State:AL
Mailing Address - Zip Code:36277-3901
Mailing Address - Country:US
Mailing Address - Phone:256-689-9983
Mailing Address - Fax:
Practice Address - Street 1:1005 LUJAN HILL RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-6304
Practice Address - Country:US
Practice Address - Phone:575-523-4573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2168252225200000X
NMPT-2023-2227225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant