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NPI Code Detail

MEDICARE: ASHLEY WIMMER PTA

MEDICARE: ASHLEY WIMMER 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
1225200000XPhysical Therapy Assistant2306601650VA

General Provider Information

NPI Number : 1629264387
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY WIMMER PTA
Provider Business Mailing Address
First Line : 2414 FLORALAND DR.
Second Line :
City : ROANOKE
State : VA
Zip : 24012
Country : US
Telephone Number : 540-293-7648
Fax Number :
Provider Business Practice Location Address
First Line : 2125 HILLIARD RD
Second Line :
City : RICHMOND
State : VA
Zip : 23228-4600
Country : US
Telephone Number : 804-266-9666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2007
Last Update Date : 09/17/2007

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