MEDICARE: ASHLEY RAE FREE LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT.0025848	CO

General Provider Information

NPI Number	:	1588340780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY RAE FREE LMT

Provider Business Mailing Address
First Line	:	3685 ROBERTS ST
Second Line	:
City	:	MEAD
State	:	CO
Zip	:	80542-4539
Country	:	US
Telephone Number	:	316-895-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1503 MOUNTAIN VIEW AVE
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-3201
Country	:	US
Telephone Number	:	316-895-1900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2023
Last Update Date	:	06/23/2023

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