Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 3550 | CO |
NPI | 1003059155 |
---|---|
Provider Name | Ashly Janel Edwards |
First Address | Lakewood, CO 80227-2841 |
Second Address | Lakewood, CO 80227-2841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2009 |
Last Update Date | 18/04/2009 |