MEDICARE: ASHLEY GREGORY PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2105471	TX

General Provider Information

NPI Number	:	1053724153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY GREGORY PTA

Provider Business Mailing Address
First Line	:	PO BOX 580526
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77258-0526
Country	:	US
Telephone Number	:	281-837-7571
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 N HIGHWAY 146
Second Line	:	A
City	:	BAYTOWN
State	:	TX
Zip	:	77520-2252
Country	:	US
Telephone Number	:	281-837-7571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2014
Last Update Date	:	08/28/2015

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Directions to “ ASHLEY GREGORY PTA” Practice Location

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