Provider Demographics
NPI:1497967582
Name:BARNETT, ASHLEY RAE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:RAE
Last Name:BARNETT
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 1:790 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:630-759-9510
Practice Address - Street 1:21806 103RD AVENUE CT E
Practice Address - Street 2:SUITE 103
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8115
Practice Address - Country:US
Practice Address - Phone:253-847-3700
Practice Address - Fax:253-847-9622
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160002719225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant