MEDICARE: ASHLEY KRISTEN MILLIKAN PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	8834A	AZ

General Provider Information

NPI Number	:	1083907117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY KRISTEN MILLIKAN PTA

Provider Business Mailing Address
First Line	:	4211 E PALM LN UNIT 121
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-3129
Country	:	US
Telephone Number	:	602-689-0486
Fax Number	:

Provider Business Practice Location Address
First Line	:	2852 N NAVAJO DR STE A
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-4966
Country	:	US
Telephone Number	:	928-772-9797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2011
Last Update Date	:	09/06/2011

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