Provider Demographics
NPI:1972641421
Name:CARPENTER, KATHLEEN D (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:D
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 BENCH CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1652
Mailing Address - Country:US
Mailing Address - Phone:907-337-2923
Mailing Address - Fax:
Practice Address - Street 1:909 BENCH CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1652
Practice Address - Country:US
Practice Address - Phone:907-337-2923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPT 261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT 261OtherAK STATE LICENSE NUMBER
AKPT0261Medicaid