Provider Demographics
NPI:1366625287
Name:ASHWORTH, CARRIE JEAN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JEAN
Last Name:ASHWORTH
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:JEAN
Other - Last Name:BOBBITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:3617 NW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-3510
Mailing Address - Country:US
Mailing Address - Phone:360-991-3493
Mailing Address - Fax:
Practice Address - Street 1:8221 NE HAZEL DELL AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8153
Practice Address - Country:US
Practice Address - Phone:360-991-3493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022474172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist