Provider Demographics
NPI:1255743662
Name:SUMMERS, ASHLEY MARIE (PTA)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:SUMMERS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4741 CULLEN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-5801
Mailing Address - Country:US
Mailing Address - Phone:937-831-1916
Mailing Address - Fax:
Practice Address - Street 1:1600 SAINT PARIS PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1226
Practice Address - Country:US
Practice Address - Phone:937-399-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07704225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant