MEDICARE: ASHLEY BETZ

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	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1689029076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY BETZ

Provider Business Mailing Address
First Line	:	165 MEAD ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-4421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 MEAD ST
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-4421
Country	:	US
Telephone Number	:	716-249-1958
Fax Number	:

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

Provider Enumeration Date	:	05/04/2016
Last Update Date	:	05/04/2016

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Directions to “ ASHLEY BETZ ” Practice Location

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