Provider Demographics
NPI:1538520069
Name:ASHMORE, CONSTANCE (PT)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:ASHMORE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 N HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-2829
Mailing Address - Country:US
Mailing Address - Phone:208-870-1923
Mailing Address - Fax:
Practice Address - Street 1:2117 N HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-2829
Practice Address - Country:US
Practice Address - Phone:208-870-1923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT1357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist