Provider Demographics
NPI:1316467392
Name:POWELL, ASHLEY RAENEE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RAENEE
Last Name:POWELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3917 EDGEBROOK CT
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-1434
Mailing Address - Country:US
Mailing Address - Phone:432-288-3159
Mailing Address - Fax:
Practice Address - Street 1:2111 RIVERWALK DR
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2700
Practice Address - Country:US
Practice Address - Phone:405-793-7885
Practice Address - Fax:405-793-7893
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4942225100000X
TX1343764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist