Provider Demographics
NPI:1336534049
Name:PEARCE, ASHLEY DAWN (PT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DAWN
Last Name:PEARCE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:DAWN
Other - Last Name:RYSDAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1050 W ELM AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-2713
Mailing Address - Country:US
Mailing Address - Phone:541-567-5678
Mailing Address - Fax:
Practice Address - Street 1:1050 W ELM AVE STE 130
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2713
Practice Address - Country:US
Practice Address - Phone:541-567-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist