Individual
GENVIEVE NICOLE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4771 TRIER RD, FORT WAYNE, IN 46815-4968
(260) 492-8300
Mailing address
4771 TRIER RD, FORT WAYNE, IN 46815-4968
(260) 492-8300
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT21906886
IN
Other
Enumeration date
08/17/2019
Last updated
08/17/2019
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