Provider Demographics
NPI:1104157379
Name:SMITH, ASHLEY (MPT)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:12844 COLDWATER RD
Mailing Address - Street 2:STE B
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-8833
Mailing Address - Country:US
Mailing Address - Phone:260-744-5585
Mailing Address - Fax:260-744-5586
Practice Address - Street 1:5800 FAIRFIELD AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46807-3400
Practice Address - Country:US
Practice Address - Phone:260-744-5585
Practice Address - Fax:260-744-5586
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN05010178A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist