Provider Demographics
NPI:1891465852
Name:GRUENKE, ASHLEY (LMT)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:GRUENKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-2245
Mailing Address - Country:US
Mailing Address - Phone:920-459-9090
Mailing Address - Fax:920-459-7426
Practice Address - Street 1:4000 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-2245
Practice Address - Country:US
Practice Address - Phone:920-459-9090
Practice Address - Fax:920-459-7426
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14104-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist