Individual
MRS. JETTA MELINDA BENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
638 UPTOWN BLVD, SUITE 1105, CEDAR HILL, TX 75104-3507
(469) 272-3129
(469) 272-3145
Mailing address
638 UPTOWN BLVD, SUITE 1105, CEDAR HILL, TX 75104-3507
(469) 272-3129
(469) 272-3145
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
1106805
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8T1319
BCBS
TX
Enumeration date
03/09/2006
Last updated
01/23/2014
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