Provider Demographics
NPI:1215250352
Name:MOSS, ASHLEY L (ATC)
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:L
Last Name:MOSS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 WALTON AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-1845
Mailing Address - Country:US
Mailing Address - Phone:717-525-0181
Mailing Address - Fax:
Practice Address - Street 1:201 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-2625
Practice Address - Country:US
Practice Address - Phone:717-566-5312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0042132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer