Basic Information
| Provider Information | |||||||||
| NPI: | 1013435668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WERTMAN | ||||||||
| FirstName: | ASHLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 TAVERN RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | MARTINSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254012853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042636165 | ||||||||
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| Practice Location | |||||||||
| Address1: | 46 TRIFECTA PLACE STE 104 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047289090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2017 | ||||||||
| LastUpdateDate: | 05/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT003904 | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.