Basic Information
| Provider Information | |||||||||
| NPI: | 1437462280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARPENTER | ||||||||
| FirstName: | JENNA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOZ 1475 | ||||||||
| Address2: | |||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503051475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5156435690 | ||||||||
| FaxNumber: | 5156435691 | ||||||||
| Practice Location | |||||||||
| Address1: | 5900 E UNIVERSITY AVE | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | PLEASANT HILL | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503278466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5156435690 | ||||||||
| FaxNumber: | 5156435691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2010 | ||||||||
| LastUpdateDate: | 07/12/2013 | ||||||||
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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 | 004545 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.