Provider Demographics
NPI:1639724560
Name:SMITH, ASHLEY M (DPT, PT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 GILLETTE ST APT 21
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-3090
Mailing Address - Country:US
Mailing Address - Phone:815-276-1712
Mailing Address - Fax:
Practice Address - Street 1:115 PERRY HWY STE 136
Practice Address - Street 2:
Practice Address - City:HARMONY
Practice Address - State:PA
Practice Address - Zip Code:16037-9205
Practice Address - Country:US
Practice Address - Phone:724-452-1277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24404225100000X
PA028503225100000X
WI15676-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist