Healthcare Provider Details

I. General information

NPI: 1902007503
Provider Name (Legal Business Name): KATHY CARPENTER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 S SEMINOLE AVE
MINNEOLA FL
34715-5520
US

IV. Provider business mailing address

1787 N WOODBURY CT
APOPKA FL
32712-2080
US

V. Phone/Fax

Practice location:
  • Phone: 352-394-0212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2856
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: