Healthcare Provider Details

I. General information

NPI: 1760701601
Provider Name (Legal Business Name): ASHLEA R. LYTLE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEA R KRAMER DPT

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 11/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 OUTLOOK BLVD 96
PUEBLO CO
81008-1667
US

IV. Provider business mailing address

3119 SPAULDING AVE. 301
PUEBLO CO
81008
US

V. Phone/Fax

Practice location:
  • Phone: 719-562-6200
  • Fax: 719-562-6225
Mailing address:
  • Phone: 785-383-6135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: