Active NPI
Nicholas Carpenter
- Physical Therapist
- Fort Walton Beach, FL
National Provider Identifier
1104797471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT41260
- Practice address
- 1000 Mar Walt Dr
Fort Walton Beach, FL 32547-6708 - Phone
- (850) 862-1111
- NPI assigned
- Sep 17, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT41260 | FL | Primary |
Addresses
Primary practice location
1000 Mar Walt Dr
Fort Walton Beach, FL 32547-6708
Mailing address
1957 Teal Cir
Gulf Breeze, FL 32563-8979
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT41260 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1758067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758067200000",
"number": "1104797471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1957 TEAL CIR",
"city": "GULF BREEZE",
"state": "FL",
"postal_code": "325638979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 MAR WALT DR",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325476708",
"telephone_number": "850-862-1111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARPENTER",
"first_name": "NICHOLAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-09-17",
"last_updated": "2025-09-17",
"certification_date": "2025-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT41260",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Walton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.