Provider Demographics
NPI:1629264387
Name:WIMMER, ASHLEY (PTA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WIMMER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 FLORALAND DR.
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012
Mailing Address - Country:US
Mailing Address - Phone:540-293-7648
Mailing Address - Fax:
Practice Address - Street 1:2125 HILLIARD RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-4600
Practice Address - Country:US
Practice Address - Phone:804-266-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306601650225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant