Provider Demographics
NPI:1497004220
Name:CLEMONS, ASHLEY M (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:M
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:410 N WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-9462
Mailing Address - Country:US
Mailing Address - Phone:517-279-7887
Mailing Address - Fax:517-279-6527
Practice Address - Street 1:410 N WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-9462
Practice Address - Country:US
Practice Address - Phone:567-208-1388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI27-1339835OtherTAX ID #