Provider Demographics
NPI:1922413848
Name:SHORT, ASHLEY (LMT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:SHORT
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 1:302 E 28TH ST APT C
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3070
Mailing Address - Country:US
Mailing Address - Phone:360-949-8295
Mailing Address - Fax:
Practice Address - Street 1:911 SE 60TH AVE APT 204
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-2835
Practice Address - Country:US
Practice Address - Phone:541-206-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60459087225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist