Provider Demographics
NPI:1083712335
Name:CARPENTER, DANA S (LPTA)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:S
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 HYDE DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35654-3229
Mailing Address - Country:US
Mailing Address - Phone:256-974-1146
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1268
Practice Address - Country:US
Practice Address - Phone:256-974-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA464225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant