Provider Demographics
NPI:1891013769
Name:ASHLOCK, JULIE M (LMT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:ASHLOCK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 HICKORY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-7953
Mailing Address - Country:US
Mailing Address - Phone:813-373-8312
Mailing Address - Fax:
Practice Address - Street 1:2915 HICKORY GROVE DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-7953
Practice Address - Country:US
Practice Address - Phone:813-373-8312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL56747225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist