Healthcare Provider Details

I. General information

NPI: 1104052737
Provider Name (Legal Business Name): JASMINE CARPENTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MEDICAL DR
CARMEL IN
46032-2923
US

IV. Provider business mailing address

3607 QUINCY DR
ANDERSON IN
46011-4744
US

V. Phone/Fax

Practice location:
  • Phone: 317-573-1037
  • Fax: 866-785-4924
Mailing address:
  • Phone: 765-617-4356
  • Fax: 866-785-4924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06002521A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: