Healthcare Provider Details

I. General information

NPI: 1265098289
Provider Name (Legal Business Name): ASHLEY C WOLTMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 BROADWAY AVE N
ROCHESTER MN
55906-4159
US

IV. Provider business mailing address

1509 SOUTHCROSS DR W
BURNSVILLE MN
55306-6945
US

V. Phone/Fax

Practice location:
  • Phone: 507-322-3460
  • Fax:
Mailing address:
  • Phone: 952-491-9810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13068
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: