Provider Demographics
NPI:1760501787
Name:CARPENTER-BREEDING, CARLA WESTON (MPT)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:WESTON
Last Name:CARPENTER-BREEDING
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7310 RITCHIE HWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3065
Mailing Address - Country:US
Mailing Address - Phone:410-766-4047
Mailing Address - Fax:410-766-4049
Practice Address - Street 1:21 CROSSROADS DR
Practice Address - Street 2:SUITE 450
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5441
Practice Address - Country:US
Practice Address - Phone:410-581-8140
Practice Address - Fax:410-356-0885
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD17806225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD227925ZAVLOtherMEDICARE PTAN
MD227925YZUMedicare PIN