MEDICARE: ASHLEY ELIZABETH PROSSER DPT

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	2251P0200X	Pediatric Physical Therapist	010095	GA
2	2251P0200X	Pediatric Physical Therapist	9734	TN

General Provider Information

NPI Number	:	1679889984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ELIZABETH PROSSER DPT

Provider Business Mailing Address
First Line	:	5819 WINDING LN STE 101
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-4067
Country	:	US
Telephone Number	:	615-512-8448
Fax Number	:	800-470-1905

Provider Business Practice Location Address
First Line	:	5819 WINDING LN STE 101
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-4067
Country	:	US
Telephone Number	:	615-512-8448
Fax Number	:	800-470-1905

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

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	05/26/2022

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