Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT9252L | PA |
NPI | 1124299961 |
---|---|
Provider Name | Tami Carpenter |
First Address | Pennsburg, PA 18073-2327 |
Second Address | Pennsburg, PA 18073-2327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2008 |
Last Update Date | 20/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1019320830001 | LEGACY NUMBER (01) | PA |