Provider Demographics
NPI:1396413043
Name:WEBB, CAROLYNN JESSAMYN (DPT, PT)
Entity Type:Individual
Prefix:
First Name:CAROLYNN
Middle Name:JESSAMYN
Last Name:WEBB
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 WOODROW AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1237
Mailing Address - Country:US
Mailing Address - Phone:760-271-0328
Mailing Address - Fax:
Practice Address - Street 1:1335 COFFEE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3188
Practice Address - Country:US
Practice Address - Phone:209-576-1946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist