Provider Demographics
NPI:1841914769
Name:CARPENTER, MARY CHARLOTTE (DPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CHARLOTTE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BITTERROOT LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9507
Mailing Address - Country:US
Mailing Address - Phone:912-414-7804
Mailing Address - Fax:
Practice Address - Street 1:123 CANAL ST
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4103
Practice Address - Country:US
Practice Address - Phone:912-988-1283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist