Provider Demographics
NPI:1841744323
Name:BILLINGSLEY, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BILLINGSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12119 SE STEVENS CT
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-2620
Mailing Address - Country:US
Mailing Address - Phone:503-353-1278
Mailing Address - Fax:503-353-1273
Practice Address - Street 1:12550 SE 93RD AVE
Practice Address - Street 2:SITE 265
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9786
Practice Address - Country:US
Practice Address - Phone:503-659-9155
Practice Address - Fax:503-659-7336
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500712147Medicaid
ORR189796Medicare PIN