Provider Demographics
NPI:1447379839
Name:CARPENTER, REBBECCA M (PT)
Entity Type:Individual
Prefix:MISS
First Name:REBBECCA
Middle Name:M
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:1300 SWANSEA AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-2521
Mailing Address - Country:US
Mailing Address - Phone:805-652-6727
Mailing Address - Fax:805-652-6026
Practice Address - Street 1:300 HILLMONT AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1651
Practice Address - Country:US
Practice Address - Phone:805-652-6727
Practice Address - Fax:805-652-6026
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27875167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician