Individual
GWYN L BENNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15756
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071378301
—
MD
01
—
44002
MAMSI
MD
01
—
52788201
CAREFIRST
MD
01
—
S4020003
FED BCBS
MD
Enumeration date
04/24/2007
Last updated
07/23/2010
Update your record
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