Provider Demographics
NPI:1225619018
Name:CARPENTER, JAMES AUSTIN
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:AUSTIN
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 HONEYCUTT RD
Mailing Address - Street 2:
Mailing Address - City:GORE SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38929-9593
Mailing Address - Country:US
Mailing Address - Phone:662-582-8054
Mailing Address - Fax:
Practice Address - Street 1:627 MIDDLETON RD STE 600
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-2021
Practice Address - Country:US
Practice Address - Phone:662-283-1260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPTA7044225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant