Provider Demographics
NPI:1700818374
Name:CARPENTER, DOUGLAS OREN (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:OREN
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-2041
Mailing Address - Country:US
Mailing Address - Phone:724-728-2319
Mailing Address - Fax:
Practice Address - Street 1:801 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:PA
Practice Address - Zip Code:15066-1929
Practice Address - Country:US
Practice Address - Phone:724-847-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0034102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer