Healthcare Provider Details

I. General information

NPI: 1477670875
Provider Name (Legal Business Name): ROBERT AVERY CARPENTER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 LONGS POND RD STE H
LEXINGTON SC
29073-7400
US

IV. Provider business mailing address

PO BOX 1590
LEXINGTON SC
29071-1590
US

V. Phone/Fax

Practice location:
  • Phone: 803-358-9400
  • Fax: 803-358-9898
Mailing address:
  • Phone: 803-358-9400
  • Fax: 803-358-9898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4743
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: