Provider Demographics
NPI:1598094914
Name:ASHBURN, JEFFREY MICHAEL (CMT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:ASHBURN
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:MR
Other - First Name:BODHI
Other - Middle Name:
Other - Last Name:ASHBURN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:1240 POWELL ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2600
Mailing Address - Country:US
Mailing Address - Phone:510-697-2105
Mailing Address - Fax:
Practice Address - Street 1:1240 POWELL ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2600
Practice Address - Country:US
Practice Address - Phone:510-697-2105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist