Provider Demographics
NPI:1518488642
Name:CULLENBERG, ASHTEN HACKETT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ASHTEN
Middle Name:HACKETT
Last Name:CULLENBERG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ASHTEN
Other - Middle Name:ALEXIS
Other - Last Name:HACKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 OLD PIKE RD
Mailing Address - Street 2:
Mailing Address - City:CORNISH
Mailing Address - State:ME
Mailing Address - Zip Code:04020-3506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 OLD PIKE RD
Practice Address - Street 2:
Practice Address - City:CORNISH
Practice Address - State:ME
Practice Address - Zip Code:04020-3506
Practice Address - Country:US
Practice Address - Phone:207-625-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist