Provider Demographics
NPI:1194056168
Name:HARDVILLE, ASHANTA
Entity type:Individual
Prefix:
First Name:ASHANTA
Middle Name:
Last Name:HARDVILLE
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 1:15230 E ILIFF AVE STE A
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4538
Mailing Address - Country:US
Mailing Address - Phone:303-751-1881
Mailing Address - Fax:303-695-1198
Practice Address - Street 1:15230 E ILIFF AVE STE A
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4538
Practice Address - Country:US
Practice Address - Phone:303-751-1881
Practice Address - Fax:303-695-1198
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8765225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist