Healthcare Provider Details

I. General information

NPI: 1215484639
Provider Name (Legal Business Name): ASHLEY LYNN TEETS DPT, PT, ATC, AT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E MAIN ST STE C
PAYSON AZ
85541-5488
US

IV. Provider business mailing address

407 S TELEGRAPH RD
MONROE MI
48161-1611
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-1950
  • Fax:
Mailing address:
  • Phone: 734-240-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberLPT-0340033
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501302086
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: