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General NPI Number Information
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NPI Number | 1215447834
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Entity Type | Individual
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Provider Name | ASHTON NANETTE WEDEMEYER PT
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Gender | Female
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 124 N ADERHOLT LOOP
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City | CANNON AFB
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State | NM
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Zip | 88103
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Country | US
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Telephone | 575-904-3506
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Fax |
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Provider Business Mailing Address
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Address Line | 224 W D.L. INGRAM AVE BUILDING 1408
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City | CANNON AFB
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State | NM
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Zip | 88103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT60917645
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P17340
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-2023-2185
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License Number State | NM
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