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NPI Code Detail

MEDICARE: KRISTIN JAYNE CARPENTER PT, DPT, OCS, FAAOMP

MEDICARE: KRISTIN JAYNE CARPENTER PT, DPT, OCS, FAAOMP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist10053CO

General Provider Information

NPI Number : 1245480011
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN JAYNE CARPENTER PT, DPT, OCS, FAAOMP
Provider Business Mailing Address
First Line : 801 MAIN ST
Second Line : STE 25
City : LOUISVILLE
State : CO
Zip : 80027-1898
Country : US
Telephone Number : 303-870-9271
Fax Number :
Provider Business Practice Location Address
First Line : 2831 SHADOW LAKE RD
Second Line :
City : LAFAYETTE
State : CO
Zip : 80026-8970
Country : US
Telephone Number : 303-870-9271
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2008
Last Update Date : 01/12/2016

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