Provider Demographics
NPI:1639874266
Name:BURTON, ASHLEY (LMT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1112 HARBOR LNDG
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3119
Mailing Address - Country:US
Mailing Address - Phone:443-362-2015
Mailing Address - Fax:
Practice Address - Street 1:1112 HARBOR LNDG
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3119
Practice Address - Country:US
Practice Address - Phone:404-919-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT014238225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist