Provider Demographics
NPI:1346076684
Name:LATIMER, ASHLEY KAY (PT, DPT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KAY
Last Name:LATIMER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:KAY
Other - Last Name:NETHING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14540 112TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7560
Mailing Address - Country:US
Mailing Address - Phone:763-656-8792
Mailing Address - Fax:
Practice Address - Street 1:2805 CAMPUS DR STE 345
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2679
Practice Address - Country:US
Practice Address - Phone:763-236-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist