Provider Demographics
NPI:1972890176
Name:WAGER, ASHLEY PAYNE (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:PAYNE
Last Name:WAGER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:MAILSTOP 275 SH2
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-2450
Mailing Address - Fax:802-847-3756
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:MAILSTOP 275 SH2
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-2450
Practice Address - Fax:802-847-3756
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0077400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist