Provider Demographics
NPI:1679220529
Name:ASHLEY, LEVI (LMT)
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:
Last Name:ASHLEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12267 SE STEELE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-4237
Mailing Address - Country:US
Mailing Address - Phone:503-501-8719
Mailing Address - Fax:
Practice Address - Street 1:12267 SE STEELE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-4237
Practice Address - Country:US
Practice Address - Phone:503-501-8719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22137225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist