Healthcare Provider Details

I. General information

NPI: 1235568668
Provider Name (Legal Business Name): CARPENTER HEALTH AND WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 11/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5006 CABRETTA DR
MOSELEY VA
23120-1559
US

IV. Provider business mailing address

5006 CABRETTA DR
MOSELEY VA
23120-1559
US

V. Phone/Fax

Practice location:
  • Phone: 804-690-8268
  • Fax: 804-739-9165
Mailing address:
  • Phone: 804-690-8268
  • Fax: 804-739-9165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2305203835
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL T CARPENTER JR.
Title or Position: CEO
Credential: DPT
Phone: 804-690-7973