Provider Demographics
NPI:1245437573
Name:CARPENTER, KRISTIN (LMT)
Entity type:Individual
Prefix:
First Name:KRISTIN
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 1:2855 JORDAN AVE S APT 411
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-3511
Mailing Address - Country:US
Mailing Address - Phone:612-396-5295
Mailing Address - Fax:763-550-9998
Practice Address - Street 1:12805 HIGHWAY 55
Practice Address - Street 2:SUITE 210
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3859
Practice Address - Country:US
Practice Address - Phone:763-550-0892
Practice Address - Fax:763-550-9998
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist