Provider Demographics
NPI:1588230437
Name:PAIT, ASHLEY LYNN
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYNN
Last Name:PAIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 ACORN LN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-5606
Mailing Address - Country:US
Mailing Address - Phone:502-558-2903
Mailing Address - Fax:
Practice Address - Street 1:3626 GRANT LINE RD STE 105
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2399
Practice Address - Country:US
Practice Address - Phone:812-944-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99104602A225100000X
IN05014276A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist