Provider Demographics
NPI:1063740801
Name:MOSELEY, ASHLEY TARA (LMT)
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:TARA
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8760 SW 21ST CT
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6732
Mailing Address - Country:US
Mailing Address - Phone:904-334-2125
Mailing Address - Fax:
Practice Address - Street 1:8760 SW 21ST CT
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6732
Practice Address - Country:US
Practice Address - Phone:904-334-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44867173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist