Provider Demographics
NPI:1336330315
Name:KREGER, ASHLEY AMBER (PT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:AMBER
Last Name:KREGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:AMBER
Other - Last Name:KIERSTED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:79 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-2536
Mailing Address - Country:US
Mailing Address - Phone:203-233-1711
Mailing Address - Fax:
Practice Address - Street 1:2010 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5608
Practice Address - Country:US
Practice Address - Phone:310-878-2540
Practice Address - Fax:310-878-2536
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18011225100000X
CA41300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist