Healthcare Provider Details

I. General information

NPI: 1518514454
Provider Name (Legal Business Name): ASHLEY NICOLE HETTICH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY NICOLE ALBINGER PT, DPT

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 S MOUNTIN DR
MAYVILLE WI
53050-1498
US

IV. Provider business mailing address

W310S196 MAPLE AVE
WAUKESHA WI
53188-9340
US

V. Phone/Fax

Practice location:
  • Phone: 920-387-7560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14842
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: