Provider Demographics
NPI:1093557548
Name:COLLEY, ASJA DANNYELLE (PT)
Entity type:Individual
Prefix:MRS
First Name:ASJA
Middle Name:DANNYELLE
Last Name:COLLEY
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 1:9001 WESLEYAN RD STE 212
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1150
Mailing Address - Country:US
Mailing Address - Phone:317-519-5118
Mailing Address - Fax:
Practice Address - Street 1:9001 WESLEYAN RD STE 212
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1150
Practice Address - Country:US
Practice Address - Phone:317-519-5118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 225700000X, 273Y00000X
IN225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171400000XOther Service ProvidersHealth & Wellness Coach
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No273Y00000XHospital UnitsRehabilitation Unit