MEDICARE: ASHLEY CARMODY MWONGELA 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	225100000X	Physical Therapist
2	225100000X	Physical Therapist	5203	NH

General Provider Information

NPI Number	:	1518431527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY CARMODY MWONGELA DPT

Provider Business Mailing Address
First Line	:	10 COMMERCE PARK N STE 1B
Second Line	:
City	:	BEDFORD
State	:	NH
Zip	:	03110-6950
Country	:	US
Telephone Number	:	801-879-6377
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 COMMERCE PARK N STE 1B
Second Line	:
City	:	BEDFORD
State	:	NH
Zip	:	03110-6950
Country	:	US
Telephone Number	:	603-644-8334
Fax Number	:

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

Provider Enumeration Date	:	01/14/2019
Last Update Date	:	10/03/2024

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