MEDICARE: CONSTANCE ASHMORE P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	RPT1357	ID

General Provider Information

NPI Number	:	1538520069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANCE ASHMORE P.T.

Provider Business Mailing Address
First Line	:	2117 N HEIGHTS DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-2829
Country	:	US
Telephone Number	:	208-870-1923
Fax Number	:

Provider Business Practice Location Address
First Line	:	2117 N HEIGHTS DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-2829
Country	:	US
Telephone Number	:	208-870-1923
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2016
Last Update Date	:	03/10/2016

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Directions to “ CONSTANCE ASHMORE P.T.” Practice Location

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