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General NPI Number Information
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NPI Number | 1457817561
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Entity Type | Individual
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Provider Name | CLYDE E CARPER III LMT
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Gender | Male
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 02/13/2019
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Provider Practice Location Address
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Address Line | 410 9TH ST
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City | GOLDEN
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State | CO
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Zip | 80401-1066
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Country | US
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Telephone | 303-859-6632
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Fax |
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Provider Business Mailing Address
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Address Line | 919 3RD ST APT 2
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City | GOLDEN
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State | CO
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Zip | 80403-1400
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Country | US
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Telephone | 303-859-6632
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT.0015060
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License Number State | CO
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