Provider Demographics
NPI:1679092696
Name:CARPENTER, KRAIG (DPT)
Entity type:Individual
Prefix:
First Name:KRAIG
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10809 S SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7033
Mailing Address - Country:US
Mailing Address - Phone:810-695-8700
Mailing Address - Fax:
Practice Address - Street 1:10809 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7033
Practice Address - Country:US
Practice Address - Phone:810-695-8700
Practice Address - Fax:810-695-7946
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010184212081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine