Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1125466 | TX |
NPI | 1003195405 |
---|---|
Provider Name | Timothy Carpenter |
First Address | Vernon, TX 76384-3135 |
Second Address | Vernon, TX 76384-3135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2011 |
Last Update Date | 16/08/2011 |