Provider Demographics
NPI:1326410630
Name:ROSEN, ASHLEY L (LMT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:ROSEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:LAURA
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:19 BELLWETHER WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2966
Mailing Address - Country:US
Mailing Address - Phone:360-647-2805
Mailing Address - Fax:
Practice Address - Street 1:19 BELLWETHER WAY STE 101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-647-2805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60555471225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist