Healthcare Provider Details

I. General information

NPI: 1811315708
Provider Name (Legal Business Name): ASHLEY BURCH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 SOUTHERN BLVD STE 5650
KETTERING OH
45429-1263
US

IV. Provider business mailing address

2204 CALUMET ST
CINCINNATI OH
45219-1814
US

V. Phone/Fax

Practice location:
  • Phone: 937-294-3611
  • Fax:
Mailing address:
  • Phone: 937-638-9437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA.08050
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: