Provider Demographics
NPI:1992140321
Name:CARPENTER, DEBBIE A (CERTIFIED MASSAGE TH)
Entity type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:A
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:CERTIFIED MASSAGE TH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7342 CASTILE CT
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-3406
Mailing Address - Country:US
Mailing Address - Phone:707-206-1321
Mailing Address - Fax:
Practice Address - Street 1:1476 PROFESSIONAL DR STE 503
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1500
Practice Address - Country:US
Practice Address - Phone:707-206-1321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist