Provider Demographics
NPI:1093802969
Name:CHARPENTIER, MARIE T (DPT ATC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:T
Last Name:CHARPENTIER
Suffix:
Gender:F
Credentials:DPT ATC
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:T
Other - Last Name:POTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8300 FLOYD CURL DR FL 3
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3931
Mailing Address - Country:US
Mailing Address - Phone:210-450-9680
Mailing Address - Fax:210-450-6054
Practice Address - Street 1:8300 FLOYD CURL DR FL 3
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3931
Practice Address - Country:US
Practice Address - Phone:210-450-9680
Practice Address - Fax:210-450-6054
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1216758225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX401878001Medicaid