Provider Demographics
NPI:1114693819
Name:MOLINA, ASHLEY LORRINE (LMT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LORRINE
Last Name:MOLINA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 LANTERN LIGHT TRL
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8735
Mailing Address - Country:US
Mailing Address - Phone:904-999-9299
Mailing Address - Fax:
Practice Address - Street 1:1427 LANTERN LIGHT TRL
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8735
Practice Address - Country:US
Practice Address - Phone:904-999-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-22
Last Update Date:2021-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA81689225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist