Provider Demographics
NPI:1265742738
Name:NIEBUHR, ASHLEY N (PT)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:N
Last Name:NIEBUHR
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 1:419 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1925
Mailing Address - Country:US
Mailing Address - Phone:315-717-0278
Mailing Address - Fax:315-717-0280
Practice Address - Street 1:2050 TILDEN AVE
Practice Address - Street 2:BOX 1000
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-3613
Practice Address - Country:US
Practice Address - Phone:315-797-3114
Practice Address - Fax:315-624-0474
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0033118-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02052091OtherMEDICAID GRP #
NY01815443Medicaid
NY00313539Medicaid
NYAA0172OtherMEDICARE GRP #
NYAA0172OtherMEDICARE GRP #
NY02052091OtherMEDICAID GRP #