=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588390579
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY HUNT LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2022
-----------------------------------------------------
Last Update Date | 08/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5127 HIGHWAY 11W
-----------------------------------------------------
City | ROGERSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37857-4086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-500-4858
-----------------------------------------------------
Fax | 423-293-0970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5127 HIGHWAY 11W
-----------------------------------------------------
City | ROGERSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37857-4086
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-438-4543
-----------------------------------------------------
Fax | 423-293-0970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 0000013969
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------