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General NPI Number Information
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NPI Number | 1104797471
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Entity Type | Individual
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Provider Name | NICHOLAS CARPENTER
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Gender | Male
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 1000 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6708
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Country | US
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Telephone | 850-862-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 1957 TEAL CIR
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City | GULF BREEZE
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State | FL
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Zip | 32563-8979
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT41260
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License Number State | FL
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