Provider Demographics
NPI:1568937381
Name:CARPENTER, DANIEL PAUL (ATC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:PAUL
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7430 N COTTAGE LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-4895
Mailing Address - Country:US
Mailing Address - Phone:435-590-7015
Mailing Address - Fax:
Practice Address - Street 1:3580 S 3600 W
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-2645
Practice Address - Country:US
Practice Address - Phone:385-646-5320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9874945-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer