Provider Demographics
NPI:1942653043
Name:CARPENTER, KAREN (LMT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 EASTBROOK BND
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1565
Mailing Address - Country:US
Mailing Address - Phone:770-313-4587
Mailing Address - Fax:
Practice Address - Street 1:23 EASTBROOK BND
Practice Address - Street 2:SUITE 202
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1565
Practice Address - Country:US
Practice Address - Phone:770-313-4587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT005375225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist