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General NPI Number Information
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NPI Number | 1467861476
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Entity Type | Organization
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Legal Business Name | ACTIVE ASHEVILLE INCORPORATED
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 370 N LOUISIANA AVE STE G4
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City | ASHEVILLE
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State | NC
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Zip | 28806-3658
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Country | US
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Telephone | 828-333-1239
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Fax |
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Provider Business Mailing Address
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Address Line | 370 N LOUISIANA AVE STE G4
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City | ASHEVILLE
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State | NC
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Zip | 28806-3658
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Country | US
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Telephone | 828-333-1239
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JONATHAN PAUL CLANCY
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Credential | LMBT
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Telephone | 828-333-1239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 14063
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License Number State | NC
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