Provider Demographics
NPI:1598528481
Name:FATTIG, ASHLEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:FATTIG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5211 CALLISTER AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-1616
Mailing Address - Country:US
Mailing Address - Phone:916-801-9706
Mailing Address - Fax:
Practice Address - Street 1:6600 BRUCEVILLE ROAD
Practice Address - Street 2:DAN B MOORE BUILDING
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823
Practice Address - Country:US
Practice Address - Phone:916-688-2096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist