Provider Demographics
NPI:1063662831
Name:COUVE, JEROME CLAUDE (LMT)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:CLAUDE
Last Name:COUVE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19107 CHERRY ROSE CIR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-9014
Mailing Address - Country:US
Mailing Address - Phone:813-926-1669
Mailing Address - Fax:
Practice Address - Street 1:7815 N DALE MABRY HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3203
Practice Address - Country:US
Practice Address - Phone:813-500-1593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 53902225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA 53902OtherMASSAGE ESTABLISHMENT