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General NPI Number Information
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NPI Number | 1790191617
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Entity Type | Individual
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Provider Name | MRS. ASHLEY RUSSELL
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Gender | Female
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Dates
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Enumeration Date | 07/11/2014
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Last Update Date | 07/11/2014
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Provider Practice Location Address
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Address Line | 1267 SOUTH HILL ROAD
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City | ERIE
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State | PA
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Zip | 16509
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Country | US
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Telephone | 814-864-4087
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Fax | 814-868-0514
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Provider Business Mailing Address
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Address Line | 1267 S HILL RD
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City | ERIE
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State | PA
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Zip | 16509-4831
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Country | US
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Telephone | 814-864-4087
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Fax | 814-868-0514
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 010127
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License Number State | PA
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