Provider Demographics
NPI:1770344855
Name:PELLETIER, ASHLEY L (LMT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:L
Last Name:PELLETIER
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 1:2155 W STATE ROUTE 89A STE 110
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-5469
Mailing Address - Country:US
Mailing Address - Phone:928-308-0999
Mailing Address - Fax:928-282-3493
Practice Address - Street 1:2155 W ST RTE 89A STE 110
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5469
Practice Address - Country:US
Practice Address - Phone:928-308-0999
Practice Address - Fax:928-282-3493
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14928225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist