Provider Demographics
NPI:1790505857
Name:COY, ASHLEY JORDAN
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JORDAN
Last Name:COY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:JORDAN
Other - Last Name:KNOBLAUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:13420 N MERIDIAN ST STE 280
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1581
Mailing Address - Country:US
Mailing Address - Phone:317-582-8170
Mailing Address - Fax:317-582-7519
Practice Address - Street 1:13420 N MERIDIAN ST STE 280
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1581
Practice Address - Country:US
Practice Address - Phone:317-582-8170
Practice Address - Fax:317-582-7519
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06005743A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant