Healthcare Provider Details

I. General information

NPI: 1629264387
Provider Name (Legal Business Name): ASHLEY WIMMER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 HILLIARD RD
RICHMOND VA
23228-4600
US

IV. Provider business mailing address

2414 FLORALAND DR.
ROANOKE VA
24012
US

V. Phone/Fax

Practice location:
  • Phone: 804-266-9666
  • Fax:
Mailing address:
  • Phone: 540-293-7648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306601650
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: