Provider Demographics
NPI:1568541811
Name:CARPENTER, MANDY MELISSA (PT)
Entity Type:Individual
Prefix:MISS
First Name:MANDY
Middle Name:MELISSA
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 1:5479 IMAGINE LN
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3563
Mailing Address - Country:US
Mailing Address - Phone:216-401-8818
Mailing Address - Fax:
Practice Address - Street 1:400 COLLIER DR
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:OH
Practice Address - Zip Code:44230-9757
Practice Address - Country:US
Practice Address - Phone:330-658-5438
Practice Address - Fax:330-658-5437
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-9528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000515941OtherANTHEM BLUE SHIELD
OH000000515941OtherANTHEM BLUE SHIELD
OH4204811Medicare PIN
OH4204812Medicare PIN