MEDICARE: ASHLEY BRISTOL LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT.0018349	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT.0018349	OTHER	CO	MASSAGE THERAPIST

General Provider Information

NPI Number	:	1588122071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY BRISTOL LMT

Provider Business Mailing Address
First Line	:	329 E PLATTE AVE
Second Line	:
City	:	FORT MORGAN
State	:	CO
Zip	:	80701-3172
Country	:	US
Telephone Number	:	970-768-7713
Fax Number	:

Provider Business Practice Location Address
First Line	:	329 E PLATTE AVE
Second Line	:
City	:	FORT MORGAN
State	:	CO
Zip	:	80701-3172
Country	:	US
Telephone Number	:	970-768-7713
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	03/04/2019

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