Provider Demographics
NPI:1477906386
Name:KIMBLE, ASHLEY RENEE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:RENEE
Last Name:KIMBLE
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 1:870 GLASFORD SQ APT 109
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-8309
Mailing Address - Country:US
Mailing Address - Phone:606-282-8584
Mailing Address - Fax:
Practice Address - Street 1:870 GLASFORD SQ APT 109
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-8309
Practice Address - Country:US
Practice Address - Phone:606-282-8584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA03304225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant