Provider Demographics
NPI:1891256822
Name:CARPENTER, KRISTIE NICHOLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:NICHOLE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 DAYSPRING DR
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1509
Mailing Address - Country:US
Mailing Address - Phone:973-362-8661
Mailing Address - Fax:
Practice Address - Street 1:2000 MEDICAL PKWY STE 404
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3746
Practice Address - Country:US
Practice Address - Phone:443-481-1140
Practice Address - Fax:443-481-1148
Is Sole Proprietor?:No
Enumeration Date:2019-03-31
Last Update Date:2019-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist