Provider Demographics
NPI:1700906880
Name:WEBBER, CAROLYN R (LMT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:R
Last Name:WEBBER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 ALT 19
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2662
Mailing Address - Country:US
Mailing Address - Phone:727-210-1136
Mailing Address - Fax:
Practice Address - Street 1:2706 ALT 19
Practice Address - Street 2:SUITE 109
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-2662
Practice Address - Country:US
Practice Address - Phone:727-210-1136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA4929225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist