Provider Demographics
NPI:1245480011
Name:CARPENTER, KRISTIN JAYNE (PT, DPT, OCS, FAAOMP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JAYNE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PT, DPT, OCS, FAAOMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MAIN ST
Mailing Address - Street 2:STE 25
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1898
Mailing Address - Country:US
Mailing Address - Phone:303-870-9271
Mailing Address - Fax:
Practice Address - Street 1:2831 SHADOW LAKE RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-8970
Practice Address - Country:US
Practice Address - Phone:303-870-9271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist