Provider Demographics
NPI:1407481914
Name:MESERVE, ROBERT EDWARD
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWARD
Last Name:MESERVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 W 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-1317
Mailing Address - Country:US
Mailing Address - Phone:206-751-3400
Mailing Address - Fax:
Practice Address - Street 1:1114 W 28TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-1317
Practice Address - Country:US
Practice Address - Phone:206-751-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist