Provider Demographics
NPI:1609267194
Name:FETROW, ASHLEY N (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:N
Last Name:FETROW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 E FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-5310
Mailing Address - Country:US
Mailing Address - Phone:575-546-2555
Mailing Address - Fax:575-546-2725
Practice Address - Street 1:722 E FLORIDA ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-5310
Practice Address - Country:US
Practice Address - Phone:575-546-2555
Practice Address - Fax:575-546-2725
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist