MEDICARE: RYAN MATTHEW CARPENTER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	11815	SC

General Provider Information

NPI Number	:	1700421054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN MATTHEW CARPENTER DPT

Provider Business Mailing Address
First Line	:	PO BOX 791217
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21279-1217
Country	:	US
Telephone Number	:	843-209-6375
Fax Number	:	843-225-0348

Provider Business Practice Location Address
First Line	:	679 ORANGEBURG RD UNIT D
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-9038
Country	:	US
Telephone Number	:	843-209-6375
Fax Number	:	843-225-0348

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2019
Last Update Date	:	06/04/2026

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Directions to “ RYAN MATTHEW CARPENTER DPT” Practice Location

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