Healthcare Provider Details

I. General information

NPI: 1508452236
Provider Name (Legal Business Name): ALLISON E CARPENTER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4463 WHITE BEAR PKWY STE 108
WHITE BEAR LAKE MN
55110-7645
US

IV. Provider business mailing address

3500 AMERICAN BLVD W STE 300
BLOOMINGTON MN
55431-4442
US

V. Phone/Fax

Practice location:
  • Phone: 651-275-4706
  • Fax: 651-770-1180
Mailing address:
  • Phone: 952-512-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14518
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: