Provider Demographics
NPI:1710116272
Name:ROSE, ASHLEY (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ROSE
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 1:258 A ST
Mailing Address - Street 2:SUITE 17
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1947
Mailing Address - Country:US
Mailing Address - Phone:541-891-1423
Mailing Address - Fax:877-466-2593
Practice Address - Street 1:258 A ST
Practice Address - Street 2:SUITE 17
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1947
Practice Address - Country:US
Practice Address - Phone:541-891-1423
Practice Address - Fax:833-231-4273
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist