Provider Demographics
NPI:1457817561
Name:CARPER, CLYDE E III (LMT)
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:E
Last Name:CARPER
Suffix:III
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 1:919 3RD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-1400
Mailing Address - Country:US
Mailing Address - Phone:303-859-6632
Mailing Address - Fax:
Practice Address - Street 1:410 9TH ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-1066
Practice Address - Country:US
Practice Address - Phone:303-859-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0015060225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist