Provider Demographics
NPI:1770215790
Name:CARVER, KRISTA RHEA (MT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:RHEA
Last Name:CARVER
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 TILDEN ST NW # A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-5219
Mailing Address - Country:US
Mailing Address - Phone:678-492-0811
Mailing Address - Fax:
Practice Address - Street 1:951A TILDEN ST NW # A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-5219
Practice Address - Country:US
Practice Address - Phone:678-492-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012304225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty