Healthcare Provider Details

I. General information

NPI: 1750009015
Provider Name (Legal Business Name): DUSTY LEE ASHFORD LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 LYNN DR
DAYTON KY
41074-1649
US

IV. Provider business mailing address

18 LYNN DR
DAYTON KY
41074-1649
US

V. Phone/Fax

Practice location:
  • Phone: 859-638-1799
  • Fax:
Mailing address:
  • Phone: 859-638-1799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number278319
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: