Provider Demographics
NPI:1063078285
Name:GANEY-ASHCRAFT, STEPHANIE R (LMBT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:GANEY-ASHCRAFT
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 TIMBERLANE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-7929
Mailing Address - Country:US
Mailing Address - Phone:828-550-5164
Mailing Address - Fax:
Practice Address - Street 1:291 TIMBERLANE RD
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-7929
Practice Address - Country:US
Practice Address - Phone:828-550-5164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15561225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist