Healthcare Provider Details

I. General information

NPI: 1255156022
Provider Name (Legal Business Name): KATHERINE ANN CARPENTER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 VILLAGE DR STE 101
FAYETTEVILLE NC
28304-4517
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-9300
  • Fax: 910-483-9302
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP23687
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: