Healthcare Provider Details

I. General information

NPI: 1821232554
Provider Name (Legal Business Name): JENNIFER CARPENTER CLAUSE P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6086 AUBURN CT
BURLINGTON KY
41005-8022
US

IV. Provider business mailing address

6086 AUBURN CT
BURLINGTON KY
41005-8022
US

V. Phone/Fax

Practice location:
  • Phone: 859-586-6607
  • Fax:
Mailing address:
  • Phone: 859-586-6607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001749
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: