Provider Demographics
NPI:1639193121
Name:CARPER, ROGER (MT)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:CARPER
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2812
Mailing Address - Country:US
Mailing Address - Phone:530-566-0132
Mailing Address - Fax:530-566-1682
Practice Address - Street 1:1025 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2812
Practice Address - Country:US
Practice Address - Phone:530-566-0132
Practice Address - Fax:530-566-1682
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0400551M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0400551MOtherMASSAGE THERAPIST