Healthcare Provider Details

I. General information

NPI: 1043160856
Provider Name (Legal Business Name): JENESSA ANN CARPENTER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 43RD AVE STE 100
MOLINE IL
61265-8401
US

IV. Provider business mailing address

104 MAIN ST
COLUMBUS JUNCTION IA
52738-1028
US

V. Phone/Fax

Practice location:
  • Phone: 309-743-2070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: