Provider Demographics
NPI:1700181856
Name:BERCOVICI, ASHLEY REBECCA
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:REBECCA
Last Name:BERCOVICI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404
Mailing Address - Country:US
Mailing Address - Phone:508-558-7321
Mailing Address - Fax:
Practice Address - Street 1:467 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404
Practice Address - Country:US
Practice Address - Phone:508-558-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist