Provider Demographics
NPI:1720438864
Name:MARSHALL, ASHLEY (MSC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 W PINE AVE
Mailing Address - Street 2:APT 4
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8324
Mailing Address - Country:US
Mailing Address - Phone:315-283-6502
Mailing Address - Fax:
Practice Address - Street 1:910 NW 16TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2265
Practice Address - Country:US
Practice Address - Phone:208-452-8060
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
IDPT-4701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist