Provider Demographics
NPI:1336303957
Name:WALLER, ASHLEY ANNE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ANNE
Last Name:WALLER
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 1:708 EARL DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-2918
Mailing Address - Country:US
Mailing Address - Phone:931-629-8739
Mailing Address - Fax:
Practice Address - Street 1:708 EARL DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2918
Practice Address - Country:US
Practice Address - Phone:931-629-8739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-13
Last Update Date:2008-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4339225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant