Provider Demographics
NPI:1275818759
Name:CARPENTER, ELMY (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELMY
Middle Name:
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 1:3 CRESCENT DR
Mailing Address - Street 2:APARTMENT 12
Mailing Address - City:THIELLS
Mailing Address - State:NY
Mailing Address - Zip Code:10984-1634
Mailing Address - Country:US
Mailing Address - Phone:845-786-4000
Mailing Address - Fax:845-786-4051
Practice Address - Street 1:51-55 N RTE 9W
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993
Practice Address - Country:US
Practice Address - Phone:845-786-4000
Practice Address - Fax:845-786-4068
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032973-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist