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General NPI Number Information
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NPI Number | 1215592647
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Entity Type | Individual
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Provider Name | JORDAN LEIGH CARPENTER PT
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Gender | Female
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 7 RIVERS DR SUITE 10 & 20
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City | HATTIESBURG
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State | MS
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Zip | 39401-1324
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Country | US
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Telephone | 601-909-5006
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Fax | 601-909-5008
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Provider Business Mailing Address
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Address Line | 921 W. BEACON ST
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City | PHILADELPHIA
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State | MS
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Zip | 39350-3229
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Country | US
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Telephone | 601-650-0002
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Fax | 601-650-9902
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT7771
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License Number State | MS
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