Provider Demographics
NPI:1144953118
Name:SPERRY, ASHE RYAN
Entity type:Individual
Prefix:
First Name:ASHE
Middle Name:RYAN
Last Name:SPERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 W MAIN ST APT 384
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4325
Mailing Address - Country:US
Mailing Address - Phone:406-839-0654
Mailing Address - Fax:
Practice Address - Street 1:147 W MAIN ST APT 384
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4325
Practice Address - Country:US
Practice Address - Phone:406-839-0654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2255A2300X2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer