Organization
BENNETT CLINIC LLC
Active
Other names
Bennett Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY EVELYN BENNETT R.N. (PARTNER)
(928) 772-7200
Entity
Organization
Contact information
Practice address
7876 E FLORENTINE RD, PRESCOTT VALLEY, AZ 86314-2216
(928) 772-7200
(928) 772-7779
Mailing address
7876 E FLORENTINE RD, PRESCOTT VALLEY, AZ 86314-2216
(928) 772-7200
(928) 772-7779
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT 6078
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z90034
MEDICARE PTAN
AZ
Enumeration date
03/12/2013
Last updated
03/12/2013
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