Individual
TRACY CARPENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMY
Contact information
Practice address
6811 118TH AVE, KENOSHA, WI 53142-8420
(262) 857-5750
Mailing address
1020 N 12TH ST, MILWAUKEE, WI 53233-1308
(414) 403-8004
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
13288-146
WI
Other
Enumeration date
03/26/2020
Last updated
03/26/2020
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