Provider Demographics
NPI:1538413539
Name:TAZZIOLI, ASHLEIGH KRISTEN (DPT)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:KRISTEN
Last Name:TAZZIOLI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 W GRAND RIVER AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2390
Mailing Address - Country:US
Mailing Address - Phone:810-534-7004
Mailing Address - Fax:810-775-1046
Practice Address - Street 1:1350 KIRTS BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4851
Practice Address - Country:US
Practice Address - Phone:248-519-4900
Practice Address - Fax:248-269-0385
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILMI6211102Medicare PIN