Provider Demographics
NPI:1265870786
Name:CARPENTER, KENNETH RAY (PT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:RAY
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 2ND ST E STE 102
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2447
Mailing Address - Country:US
Mailing Address - Phone:406-730-2224
Mailing Address - Fax:406-730-2228
Practice Address - Street 1:214 2ND ST E STE 102
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2447
Practice Address - Country:US
Practice Address - Phone:406-730-2224
Practice Address - Fax:406-730-2228
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist