Healthcare Provider Details

I. General information

NPI: 1487190807
Provider Name (Legal Business Name): ASHLEY GREEN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY D SALAZAR LMT

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4885 S 900 E STE 204
MURRAY UT
84117-5746
US

IV. Provider business mailing address

116 W 200 N
BRIGHAM CITY UT
84302-2012
US

V. Phone/Fax

Practice location:
  • Phone: 801-636-6801
  • Fax: 877-283-3682
Mailing address:
  • Phone: 253-409-7004
  • Fax: 253-409-7004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number5428699-4701
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 60689786
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1761578
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: