Provider Demographics
NPI:1215700687
Name:KEYWORTH, ASHLEY VERONIQUE (LMT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:VERONIQUE
Last Name:KEYWORTH
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 1:27602 N DENVER HILL DR
Mailing Address - Street 2:
Mailing Address - City:WITTMANN
Mailing Address - State:AZ
Mailing Address - Zip Code:85361-9683
Mailing Address - Country:US
Mailing Address - Phone:405-826-2793
Mailing Address - Fax:
Practice Address - Street 1:27602 N DENVER HILL DR
Practice Address - Street 2:
Practice Address - City:WITTMANN
Practice Address - State:AZ
Practice Address - Zip Code:85361-9683
Practice Address - Country:US
Practice Address - Phone:405-826-2793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-28924225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist