Provider Demographics
NPI:1841679883
Name:RODERICK, ASHLEE NICOLE (PT, DPT, OCS, CMPT)
Entity type:Individual
Prefix:DR
First Name:ASHLEE
Middle Name:NICOLE
Last Name:RODERICK
Suffix:
Gender:F
Credentials:PT, DPT, OCS, CMPT
Other - Prefix:
Other - First Name:ASHLEE
Other - Middle Name:
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:732 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-9725
Mailing Address - Country:US
Mailing Address - Phone:541-929-2255
Mailing Address - Fax:541-929-7055
Practice Address - Street 1:732 MAIN ST
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9725
Practice Address - Country:US
Practice Address - Phone:541-929-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR610702251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic