Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 40QA01843000 | NJ |
NPI | 1487118030 |
---|---|
Provider Name | Ashley Dembeck |
First Address | Mount Laurel, NJ 08054-3414 |
Second Address | Mount Laurel, NJ 08054-3414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2019 |
Last Update Date | 29/01/2019 |