Healthcare Provider Details

I. General information

NPI: 1447197702
Provider Name (Legal Business Name): ASHLEY AUGUSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20808 N 27TH AVE APT 2140
PHOENIX AZ
85027-3221
US

IV. Provider business mailing address

20808 N 27TH AVE APT 2140
PHOENIX AZ
85027-3221
US

V. Phone/Fax

Practice location:
  • Phone: 602-551-7495
  • Fax:
Mailing address:
  • Phone: 602-551-7495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-50290
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: