Provider Demographics
NPI:1578956280
Name:CHURCH, ASHLEY ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:CHURCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ELIZABETH
Other - Last Name:SISSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9097 E DESERT COVE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6276
Mailing Address - Country:US
Mailing Address - Phone:602-437-5055
Mailing Address - Fax:602-437-5395
Practice Address - Street 1:5750 S. 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040
Practice Address - Country:US
Practice Address - Phone:602-437-5055
Practice Address - Fax:602-437-5395
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist