Provider Demographics
NPI:1740557438
Name:GENDRON, ASHLEE RAE (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:RAE
Last Name:GENDRON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ASHLEE
Other - Middle Name:RAE
Other - Last Name:MCKEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24449 NEW HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4164
Mailing Address - Country:US
Mailing Address - Phone:760-687-5821
Mailing Address - Fax:
Practice Address - Street 1:29650 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-6521
Practice Address - Country:US
Practice Address - Phone:951-672-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA384502251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic