Provider Demographics
NPI:1265268551
Name:ASHBAUGH, JENIE (LMT)
Entity type:Individual
Prefix:
First Name:JENIE
Middle Name:
Last Name:ASHBAUGH
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 1:5991 ED HARRIS CR
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771
Mailing Address - Country:US
Mailing Address - Phone:407-928-7951
Mailing Address - Fax:
Practice Address - Street 1:1978 US 1 #107
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955
Practice Address - Country:US
Practice Address - Phone:321-802-1046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA77150225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist