Provider Demographics
NPI:1588812911
Name:BURT, ASHLEY ANNE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ANNE
Last Name:BURT
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ANNE
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:PO BOX 3930
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83816-2532
Mailing Address - Country:US
Mailing Address - Phone:208-964-5408
Mailing Address - Fax:
Practice Address - Street 1:409 N ARGONNE RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-2874
Practice Address - Country:US
Practice Address - Phone:509-924-7311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024351225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist