Provider Demographics
NPI:1700543154
Name:CARPENTER, KAITLYN LEEANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:LEEANN
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:LEEANN
Other - Last Name:HENLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1300 BRIDGE BARRIER RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-3939
Mailing Address - Country:US
Mailing Address - Phone:910-636-3574
Mailing Address - Fax:
Practice Address - Street 1:1300 BRIDGE BARRIER RD STE 3
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-3939
Practice Address - Country:US
Practice Address - Phone:910-636-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist