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General NPI Number Information
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NPI Number | 1144202938
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Entity Type | Individual
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Provider Name | DAVEE CARPENTER MUSSMANN DPT
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Gender | Female
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1224 8TH ST SUITE A
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City | RUPERT
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State | ID
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Zip | 83350-1527
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Country | US
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Telephone | 208-436-9016
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Fax |
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Provider Business Mailing Address
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Address Line | 3512 N 4500 E
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City | MURTAUGH
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State | ID
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Zip | 83344-5014
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Country | US
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Telephone | 208-432-5644
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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 | 633
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License Number State | ID
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