Basic Information
Provider Information
NPI: 1225470404
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAMON
FirstName: ASHLEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 681478
Address2:  
City: FRANKLIN
State: TN
PostalCode: 370681478
CountryCode: US
TelephoneNumber: 6155916590
FaxNumber: 6155916601
Practice Location
Address1: 2690 MADISON ST
Address2: SUITE 120
City: CLARKSVILLE
State: TN
PostalCode: 370435975
CountryCode: US
TelephoneNumber: 9313580559
FaxNumber: 9313580587
Other Information
ProviderEnumerationDate: 07/29/2013
LastUpdateDate: 09/30/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X11035TNY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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