Provider Demographics
NPI:1760780696
Name:CALVERT, MARSHALL (NCLMP)
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:
Last Name:CALVERT
Suffix:
Gender:M
Credentials:NCLMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8665 W FLAMINGO RD
Mailing Address - Street 2:PMB #131-113
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8621
Mailing Address - Country:US
Mailing Address - Phone:253-320-5415
Mailing Address - Fax:877-503-6586
Practice Address - Street 1:3085 EAST RUSSELL ROAD
Practice Address - Street 2:SUITE E
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3482
Practice Address - Country:US
Practice Address - Phone:702-433-8333
Practice Address - Fax:702-433-4632
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV3071225700000X
WAMA00025067225700000X
MO2002000659225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist