Provider Demographics
NPI:1265882211
Name:PALACIO, ASHLEY LYNN (PT, DPT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYNN
Last Name:PALACIO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LYNN
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:336 FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-3126
Mailing Address - Country:US
Mailing Address - Phone:406-375-0980
Mailing Address - Fax:
Practice Address - Street 1:336 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3126
Practice Address - Country:US
Practice Address - Phone:406-375-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTPPTLIC11076225100000X
COPTL.0013987225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist