Provider Demographics
NPI:1174572994
Name:CARPENTER, BRETT WARD (PT)
Entity type:Individual
Prefix:MR
First Name:BRETT
Middle Name:WARD
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 APPALOOSA CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-5225
Mailing Address - Country:US
Mailing Address - Phone:325-944-4399
Mailing Address - Fax:325-944-4556
Practice Address - Street 1:3126 APPALOOSA CIR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-5225
Practice Address - Country:US
Practice Address - Phone:325-944-4399
Practice Address - Fax:325-944-4556
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1090462225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX059100002Medicaid
TX86884TOtherBLUE CROSS BLUE SHIELD
TX059100002Medicaid
8A5227Medicare ID - Type Unspecified