Basic Information
| Provider Information | |||||||||
| NPI: | 1275818759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARPENTER | ||||||||
| FirstName: | ELMY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 CRESCENT DR | ||||||||
| Address2: | APARTMENT 12 | ||||||||
| City: | THIELLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109841634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457864000 | ||||||||
| FaxNumber: | 8457864051 | ||||||||
| Practice Location | |||||||||
| Address1: | 51-55 N RTE 9W | ||||||||
| Address2: | |||||||||
| City: | WEST HAVERSTRAW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457864000 | ||||||||
| FaxNumber: | 8457864068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2011 | ||||||||
| LastUpdateDate: | 11/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 032973-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.