Individual
JEFFREY R BENNETT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, ATC
Contact information
Practice address
506 E SOUTHWAY BLVD, KOKOMO, IN 46902
(765) 626-0299
(765) 864-2070
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05010397A
IN
2255A2300X
Athletic Trainer
36001638A
IN
Other
Enumeration date
09/17/2009
Last updated
02/12/2014
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