Provider Demographics
NPI:1356400394
Name:CARPENTER, BENJAMIN ROBERT (LAT, ATC, NSCF CPT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ROBERT
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:LAT, ATC, NSCF CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 LEONARDS WAY
Mailing Address - Street 2:
Mailing Address - City:ARGUSVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58005-9602
Mailing Address - Country:US
Mailing Address - Phone:701-484-5014
Mailing Address - Fax:
Practice Address - Street 1:1025 LEONARDS WAY
Practice Address - Street 2:
Practice Address - City:ARGUSVILLE
Practice Address - State:ND
Practice Address - Zip Code:58005-9602
Practice Address - Country:US
Practice Address - Phone:701-484-5014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND203-99225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist