Provider Demographics
NPI:1457041360
Name:HOAG, ASHTON MARIE
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:MARIE
Last Name:HOAG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHTON
Other - Middle Name:MARIE
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3829 VALLEY VIEW DR NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-1846
Mailing Address - Country:US
Mailing Address - Phone:612-741-4075
Mailing Address - Fax:
Practice Address - Street 1:480 OSBORNE RD NE STE 280
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2866
Practice Address - Country:US
Practice Address - Phone:763-784-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist