Provider Demographics
NPI:1063166171
Name:CONNOR, ASHLIE RENA (PT, DPT)
Entity type:Individual
Prefix:
First Name:ASHLIE
Middle Name:RENA
Last Name:CONNOR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ASHLIE
Other - Middle Name:RENA
Other - Last Name:KEITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1540 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-5095
Mailing Address - Country:US
Mailing Address - Phone:501-753-5459
Mailing Address - Fax:
Practice Address - Street 1:1540 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5095
Practice Address - Country:US
Practice Address - Phone:501-753-5459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT5089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist