Healthcare Provider Details

I. General information

NPI: 1720439243
Provider Name (Legal Business Name): ASHLEY A O'CONNOR PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2691 STATE ROUTE 9 STE 102
MALTA NY
12020-4319
US

IV. Provider business mailing address

5 PASTURE PL
BALLSTON LAKE NY
12019-1737
US

V. Phone/Fax

Practice location:
  • Phone: 518-430-2008
  • Fax: 518-633-1029
Mailing address:
  • Phone: 518-430-2008
  • Fax: 518-633-1029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040200
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: