Provider Demographics
NPI:1720305758
Name:SCHOLTZ, ASHLEY (DPT)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:SCHOLTZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:ALT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4130 S LAKE DR
Mailing Address - Street 2:#282
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:WI
Mailing Address - Zip Code:53235-5957
Mailing Address - Country:US
Mailing Address - Phone:419-376-8369
Mailing Address - Fax:
Practice Address - Street 1:8520 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4604
Practice Address - Country:US
Practice Address - Phone:414-607-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11272-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist