Provider Demographics
NPI:1366889081
Name:DINGESS, ASHLEY LEANN (PTA)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LEANN
Last Name:DINGESS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 540
Mailing Address - Street 2:3-MILE CURVE
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-0540
Mailing Address - Country:US
Mailing Address - Phone:304-752-2273
Mailing Address - Fax:
Practice Address - Street 1:55 LOGAN MINGO MENTAL HEALTH
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601
Practice Address - Country:US
Practice Address - Phone:304-752-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1181225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4511Medicaid
WV3046824511Medicare Oscar/Certification
WV4511Medicare UPIN
WV3046824511Medicare NSC
WV4511Medicare PIN