Individual
MRS. KRISTA R BENNETT
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
5050 N CLINTON ST, FORT WAYNE, IN 46825-5822
(260) 484-8551
(260) 484-3351
Mailing address
726 SUNTURN DR, FORT WAYNE, IN 46825-2295
(260) 497-9529
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
36000834A
IN
Other
Enumeration date
04/07/2006
Last updated
07/08/2007
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