Provider Demographics
NPI:1609699768
Name:ASHWORTH, ERIC DEAN (LMT, CMLDT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:DEAN
Last Name:ASHWORTH
Suffix:
Gender:M
Credentials:LMT, CMLDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 E INMAN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4659
Mailing Address - Country:US
Mailing Address - Phone:417-894-7191
Mailing Address - Fax:
Practice Address - Street 1:743 W BATTLEFIELD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4125
Practice Address - Country:US
Practice Address - Phone:417-849-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021050408225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist