Provider Demographics
NPI:1073202313
Name:ASHLEY, STEPHEN (LMT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:ASHLEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 DEERWOOD PARK BLVD STE 609B
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2811
Mailing Address - Country:US
Mailing Address - Phone:904-513-3954
Mailing Address - Fax:
Practice Address - Street 1:10550 DEERWOOD PARK BLVD STE 609B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2811
Practice Address - Country:US
Practice Address - Phone:904-513-3954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56241225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist