Provider Demographics
NPI:1972523363
Name:ASHLEY, MICHAEL B (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:B
Last Name:ASHLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1364
Mailing Address - Country:US
Mailing Address - Phone:814-864-6650
Mailing Address - Fax:814-806-2557
Practice Address - Street 1:4538 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1364
Practice Address - Country:US
Practice Address - Phone:814-864-6650
Practice Address - Fax:814-806-2557
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-005881-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA910125OtherHIGHMARK BC/BS PROVIDER #
PA1818003Medicaid
PA1818003Medicaid