Provider Demographics
NPI:1730614140
Name:DICKS, ASHLEY MORGAN
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MORGAN
Last Name:DICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:MORGAN
Other - Last Name:DICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:86 ASHLEY CT
Mailing Address - Street 2:
Mailing Address - City:MYERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21773-8414
Mailing Address - Country:US
Mailing Address - Phone:301-416-6205
Mailing Address - Fax:
Practice Address - Street 1:86 ASHLEY CT
Practice Address - Street 2:
Practice Address - City:MYERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21773-8414
Practice Address - Country:US
Practice Address - Phone:301-416-6105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-23
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist