Provider Demographics
NPI:1386079846
Name:CARPENTER, PAUL (DPT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3037
Mailing Address - Country:US
Mailing Address - Phone:320-414-0404
Mailing Address - Fax:320-348-1239
Practice Address - Street 1:104 2ND ST SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345
Practice Address - Country:US
Practice Address - Phone:320-414-0404
Practice Address - Fax:320-348-1239
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist