Healthcare Provider Details

I. General information

NPI: 1356648315
Provider Name (Legal Business Name): CHRISTINA M CARPENTER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2011
Last Update Date: 02/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 AIRLINE RD
COLUMBUS MS
39702-6348
US

IV. Provider business mailing address

717 NORTH ST
COLUMBUS MS
39702-5421
US

V. Phone/Fax

Practice location:
  • Phone: 662-327-9404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA4169
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: