Provider Demographics
NPI:1952805707
Name:DAVIS, ASHLEY M (MA48101)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA48101
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 NW AVENUE E
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-2417
Mailing Address - Country:US
Mailing Address - Phone:561-755-3358
Mailing Address - Fax:
Practice Address - Street 1:1501 NW AVENUE E
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-2417
Practice Address - Country:US
Practice Address - Phone:561-755-3358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48101225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist