Provider Demographics
NPI:1477718930
Name:CARPENTER, CARA LYNN (DPT)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:LYNN
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E STAKE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616
Mailing Address - Country:US
Mailing Address - Phone:208-939-9594
Mailing Address - Fax:208-939-9828
Practice Address - Street 1:1618 S MILLENIUM WAY STE 101
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6457
Practice Address - Country:US
Practice Address - Phone:208-884-4647
Practice Address - Fax:208-884-8984
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008586225100000X
IDPT1664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist