Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 05010575A | IN |
N | 2251P0200X | Physical Therapist - Pediatrics | 070.018485 | IL |
NPI | 1003189499 |
---|---|
Provider Name | Dr. Ashley Nicole Summers |
First Address | Kokomo, IN 46902-2375 |
Second Address | Greenwood, IN 46143-8838 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2012 |
Last Update Date | 07/07/2015 |