Provider Demographics
NPI:1851604706
Name:PHELPS, ASHLEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 NW 86TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2284
Mailing Address - Country:US
Mailing Address - Phone:515-278-8151
Mailing Address - Fax:515-278-8155
Practice Address - Street 1:5900 NW 86TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2284
Practice Address - Country:US
Practice Address - Phone:515-278-8151
Practice Address - Fax:515-278-8155
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI19172Medicare PIN
IAI19172039Medicare PIN