MEDICARE: ASHLEY DEMBECK PT, DPT

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	2251N0400X	Neurology Physical Therapist	40QA01843000	NJ

General Provider Information

NPI Number	:	1487118030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY DEMBECK PT, DPT

Provider Business Mailing Address
First Line	:	523 FELLOWSHIP RD STE 290
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-3414
Country	:	US
Telephone Number	:	856-424-5552
Fax Number	:

Provider Business Practice Location Address
First Line	:	523 FELLOWSHIP RD STE 290
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-3414
Country	:	US
Telephone Number	:	856-424-5552
Fax Number	:

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

Provider Enumeration Date	:	01/29/2019
Last Update Date	:	01/29/2019

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