Healthcare Provider Details

I. General information

NPI: 1194352385
Provider Name (Legal Business Name): ASHLEY MARIE MESHACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 COMPASS RD
GLENVIEW IL
60026-8001
US

IV. Provider business mailing address

30 STATE ROUTE 2035
NICHOLSON PA
18446-7601
US

V. Phone/Fax

Practice location:
  • Phone: 877-787-3421
  • Fax:
Mailing address:
  • Phone: 570-575-5260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE012432
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306605571
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: