Provider Demographics
NPI:1023747268
Name:ASHWORTH, ALEXANDRIA NICHOLE (LMT)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRIA
Middle Name:NICHOLE
Last Name:ASHWORTH
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 1:743 W BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4125
Mailing Address - Country:US
Mailing Address - Phone:417-849-9730
Mailing Address - Fax:
Practice Address - Street 1:743 W BATTLEFIELD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4125
Practice Address - Country:US
Practice Address - Phone:417-849-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180443715225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist