Provider Demographics
NPI:1508350885
Name:DWYER, ASHLEY SMITH (LMBT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SMITH
Last Name:DWYER
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4732 LEBANON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9112
Mailing Address - Country:US
Mailing Address - Phone:704-763-2059
Mailing Address - Fax:980-317-8495
Practice Address - Street 1:4732 LEBANON RD
Practice Address - Street 2:SUITE A
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9112
Practice Address - Country:US
Practice Address - Phone:704-763-2059
Practice Address - Fax:980-317-8495
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14844225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist