Healthcare Provider Details

I. General information

NPI: 1598098600
Provider Name (Legal Business Name): BETHANY N CARPENTER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 BRADFORD BLVD STE 500
GORDONSVILLE TN
38563
US

IV. Provider business mailing address

112 BRADFORD BLVD STE 500
GORDONSVILLE TN
38563-4618
US

V. Phone/Fax

Practice location:
  • Phone: 615-683-3490
  • Fax: 615-683-3495
Mailing address:
  • Phone: 615-683-3010
  • Fax: 615-683-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT005484
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: