Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT31020 | FL |
NPI | 1366937625 |
---|---|
Provider Name | Kathy L Carpenter |
First Address | Longwood, FL 32750-2877 |
Second Address | Palm Harbor, FL 34685-1172 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2018 |
Last Update Date | 28/06/2018 |