Provider Demographics
NPI:1336731736
Name:MARTIN, ASHLEE CAROL (PTA)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:CAROL
Last Name:MARTIN
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 1:1669 SHAKERAG RD
Mailing Address - Street 2:
Mailing Address - City:HANSON
Mailing Address - State:KY
Mailing Address - Zip Code:42413-9699
Mailing Address - Country:US
Mailing Address - Phone:270-871-0207
Mailing Address - Fax:
Practice Address - Street 1:150 CORNWALL DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-8781
Practice Address - Country:US
Practice Address - Phone:270-825-0166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA04186225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant