Healthcare Provider Details

I. General information

NPI: 1871212647
Provider Name (Legal Business Name): ASHLEY ALDRIDGE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY JOHNSON DPT

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W EDISON RD
MISHAWAKA IN
46545-2784
US

IV. Provider business mailing address

4251 LAHMEYER RD
FORT WAYNE IN
46815-5676
US

V. Phone/Fax

Practice location:
  • Phone: 574-931-2805
  • Fax:
Mailing address:
  • Phone: 260-432-4700
  • Fax: 260-459-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05014775A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: