Provider Demographics
NPI:1689753758
Name:KATZENBACK, ASHLEY JEANNE (PT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JEANNE
Last Name:KATZENBACK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 FALMOUTH RD STE E21
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-6316
Mailing Address - Country:US
Mailing Address - Phone:508-477-5670
Mailing Address - Fax:508-539-1790
Practice Address - Street 1:681 FALMOUTH RD STE E21
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-6316
Practice Address - Country:US
Practice Address - Phone:508-477-5670
Practice Address - Fax:508-539-1790
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17608225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA17608OtherMA STATE LICENSE