Provider Demographics
NPI:1093763849
Name:CARPENTER, AMBER LYNN (PT)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:LYNN
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 1:4045 WADSWORTH BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4642
Mailing Address - Country:US
Mailing Address - Phone:303-940-1611
Mailing Address - Fax:303-432-2296
Practice Address - Street 1:4045 WADSWORTH BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4642
Practice Address - Country:US
Practice Address - Phone:303-940-1611
Practice Address - Fax:303-432-2296
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7998174400000X
COPTL.0007998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO479618Medicare PIN