Provider Demographics
NPI:1396762969
Name:CARPENTER, DIANNE S (PT, DPT)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:S
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 N LITCHFIELD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7804
Mailing Address - Country:US
Mailing Address - Phone:623-935-5505
Mailing Address - Fax:623-935-5551
Practice Address - Street 1:10815 W MCDOWELL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5007
Practice Address - Country:US
Practice Address - Phone:623-907-4400
Practice Address - Fax:623-907-4610
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ85510Medicare PIN