Provider Demographics
NPI:1972275568
Name:TWYNAM, ASHLEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:TWYNAM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PATERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1227
Mailing Address - Country:US
Mailing Address - Phone:201-366-2300
Mailing Address - Fax:
Practice Address - Street 1:42 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3440
Practice Address - Country:US
Practice Address - Phone:201-366-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA016433002251X0800X
PAPT0280782251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic