Provider Demographics
NPI:1992328512
Name:NEIDERT, ASHLEY (PT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:NEIDERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S MERIDIAN AVE RM 113
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-2629
Mailing Address - Country:US
Mailing Address - Phone:316-655-3403
Mailing Address - Fax:316-267-8191
Practice Address - Street 1:1923 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3405
Practice Address - Country:US
Practice Address - Phone:316-630-9300
Practice Address - Fax:316-262-4887
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSPENDINGOtherKS STATE BOARD OF HEALING ARTS