Provider Demographics
NPI:1659786200
Name:KINGSTON, ASHLEY (LMP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:KINGSTON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2554 S MERIDIAN APT C
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1527
Mailing Address - Country:US
Mailing Address - Phone:253-720-7816
Mailing Address - Fax:
Practice Address - Street 1:818 39TH AVE SW
Practice Address - Street 2:SUITE A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3308
Practice Address - Country:US
Practice Address - Phone:253-841-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60434722225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist