Provider Demographics
NPI:1437462280
Name:CARPENTER, JENNA L (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:L
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOZ 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-5690
Mailing Address - Fax:515-643-5691
Practice Address - Street 1:5900 E UNIVERSITY AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-8466
Practice Address - Country:US
Practice Address - Phone:515-643-5690
Practice Address - Fax:515-643-5691
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist