Healthcare Provider Details

I. General information

NPI: 1063347102
Provider Name (Legal Business Name): ASHLY RACHELL YVETTE MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 COLLEGE AVE STE A2
MODESTO CA
95350-4046
US

IV. Provider business mailing address

4284 MADISON LN
TURLOCK CA
95382-7319
US

V. Phone/Fax

Practice location:
  • Phone: 209-238-9999
  • Fax:
Mailing address:
  • Phone: 650-390-7568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number97149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: