Provider Demographics
NPI:1831316942
Name:CARVER, JESSE C (LMP)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:C
Last Name:CARVER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 W AUGUSTA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-4622
Mailing Address - Country:US
Mailing Address - Phone:509-328-5046
Mailing Address - Fax:
Practice Address - Street 1:1301 N PINES RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4964
Practice Address - Country:US
Practice Address - Phone:509-922-5585
Practice Address - Fax:509-927-7336
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023510225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist