Provider Demographics
NPI:1063627495
Name:RISNER, ASHLEY LACHELLE (PT)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:LACHELLE
Last Name:RISNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 BLACKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE FINANCE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4310
Mailing Address - Country:US
Mailing Address - Phone:937-291-2954
Mailing Address - Fax:
Practice Address - Street 1:1525 E STROOP RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5065
Practice Address - Country:US
Practice Address - Phone:937-208-7410
Practice Address - Fax:937-208-7448
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0010983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist