Provider Demographics
NPI:1013266238
Name:SHORT, ASHLEY KAY (DPT)
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:KAY
Last Name:SHORT
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 1:520 N KINGSBURY ST
Mailing Address - Street 2:APT 1803
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-8766
Mailing Address - Country:US
Mailing Address - Phone:269-744-7353
Mailing Address - Fax:
Practice Address - Street 1:2649 E 75TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3835
Practice Address - Country:US
Practice Address - Phone:773-356-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.019440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist