Provider Demographics
NPI:1154160703
Name:ASHBY, MAURICE ALONZO
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:ALONZO
Last Name:ASHBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18054 MARSH PINE RD
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2867
Mailing Address - Country:US
Mailing Address - Phone:757-201-1266
Mailing Address - Fax:
Practice Address - Street 1:18054 MARSH PINE RD
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2867
Practice Address - Country:US
Practice Address - Phone:757-201-1266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019018212225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist