Provider Demographics
NPI:1033474432
Name:SHUPE, ASHLEE MARIE (PT, DPT, CLT)
Entity type:Individual
Prefix:MRS
First Name:ASHLEE
Middle Name:MARIE
Last Name:SHUPE
Suffix:
Gender:F
Credentials:PT, DPT, CLT
Other - Prefix:MISS
Other - First Name:ASHLEE
Other - Middle Name:MARIE
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:200 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-4243
Mailing Address - Country:US
Mailing Address - Phone:541-790-7700
Mailing Address - Fax:541-790-7711
Practice Address - Street 1:200 N MONROE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-4243
Practice Address - Country:US
Practice Address - Phone:541-790-7700
Practice Address - Fax:541-790-7711
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62738225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ12409672OtherCAQH
OR62738OtherPHYSICAL THERAPY LICENSE NUMBER