Provider Demographics
NPI:1184749830
Name:PEASE, CAROLYN LEVESEY
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:LEVESEY
Last Name:PEASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 E ORANGEBURG AVE
Mailing Address - Street 2:101
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5512
Mailing Address - Country:US
Mailing Address - Phone:209-574-9452
Mailing Address - Fax:209-574-0739
Practice Address - Street 1:609 E ORANGEBURG AVE
Practice Address - Street 2:101
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5512
Practice Address - Country:US
Practice Address - Phone:209-574-9452
Practice Address - Fax:209-574-0739
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist