MEDICARE: ASHLEY BIRD

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

General Provider Information

NPI Number	:	1629655360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY BIRD

Provider Business Mailing Address
First Line	:	302 PORTICO ST
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-5364
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2517 N MAIN ST
Second Line	:
City	:	NORTH NEWTON
State	:	KS
Zip	:	67117-9002
Country	:	US
Telephone Number	:	760-554-4909
Fax Number	:

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

Provider Enumeration Date	:	03/27/2021
Last Update Date	:	03/27/2021

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Directions to “ ASHLEY BIRD ” Practice Location

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