Ashley Deyonne Corn, PTA
Individual provider Active NPI Physical Therapy Assistant · Waterman, IL
NPI 1306344064 · NPPES record last updated Jan 29, 2018
Key facts
- NPI
- 1306344064
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 160007518 (IL)
- Practice address
- 125 N. Cedar St
Waterman, IL 60556 - Phone
- (815) 264-8600
- Fax
- (815) 264-8644
- NPI assigned
- Jan 29, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160007518 | IL | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wylde Physical Therapy, LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160007518 | IL | Yes |
Addresses
Primary practice location
125 N. Cedar St
Waterman, IL 60556
Mailing address
49W230 Harter Rd
Maple Park, IL 60151-8104
Phone (815) 757-0431
Other providers in Waterman, IL
All providers in Waterman, IL · Physical Therapy Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.