Healthcare Provider Details

I. General information

NPI: 1821237405
Provider Name (Legal Business Name): ASHLEY BETH ZOGRAFOS LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8921 E ALKI AVE
SPOKANE VALLEY WA
99212-2705
US

IV. Provider business mailing address

8921 E ALKI AVE
SPOKANE VALLEY WA
99212-2705
US

V. Phone/Fax

Practice location:
  • Phone: 509-928-5100
  • Fax: 509-928-1651
Mailing address:
  • Phone: 509-928-5100
  • Fax: 509-928-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60058630
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: