Provider Demographics
NPI:1992866677
Name:SMITH, ASHLEY M (DPT)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1800 BUCKNER ST
Mailing Address - Street 2:SUITE C-200
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4440
Mailing Address - Country:US
Mailing Address - Phone:318-227-9002
Mailing Address - Fax:318-227-9025
Practice Address - Street 1:1800 BUCKNER ST
Practice Address - Street 2:SUITE C-200
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4440
Practice Address - Country:US
Practice Address - Phone:318-227-9002
Practice Address - Fax:318-227-9025
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA069692251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics