Provider Demographics
NPI:1447563978
Name:WINES, ASHLEE GAIL (DPT)
Entity Type:Individual
Prefix:MISS
First Name:ASHLEE
Middle Name:GAIL
Last Name:WINES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ASHLEE
Other - Middle Name:GAIL
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:10020 PROFESSIONAL CENTER DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HAMBURG
Practice Address - State:MI
Practice Address - Zip Code:48139
Practice Address - Country:US
Practice Address - Phone:810-231-6904
Practice Address - Fax:810-231-6906
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN69750019Medicare PIN