Provider Demographics
NPI:1235684259
Name:KIELTYKA, ASHLEY (DPT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:KIELTYKA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MAJOR APPLEBY RD
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1627
Mailing Address - Country:US
Mailing Address - Phone:914-804-4855
Mailing Address - Fax:
Practice Address - Street 1:24 MAJOR APPLEBY RD
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1627
Practice Address - Country:US
Practice Address - Phone:914-804-4855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040600-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist