Provider Demographics
NPI:1023460052
Name:MCKINNEY, ASHLEIGH VICTORIA (LMT)
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:VICTORIA
Last Name:MCKINNEY
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 1:455 HILLINGDON WAY
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-8554
Mailing Address - Country:US
Mailing Address - Phone:228-282-5120
Mailing Address - Fax:
Practice Address - Street 1:455 HILLINGDON WAY
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8554
Practice Address - Country:US
Practice Address - Phone:228-282-5120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT010862225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist