Provider Demographics
NPI:1851598825
Name:KOEHN, ASHLEY ANN (PTA)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:ANN
Last Name:KOEHN
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 1:1703 LEGOMA DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46819-2009
Mailing Address - Country:US
Mailing Address - Phone:219-363-4806
Mailing Address - Fax:
Practice Address - Street 1:3811 PARNELL AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1409
Practice Address - Country:US
Practice Address - Phone:260-482-4651
Practice Address - Fax:260-483-9505
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003392A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant