Individual
MRS. HEATHER RAE BENNINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.T.C., P.T.
Contact information
Practice address
3838 12TH AVE N, FARGO, ND 58102-2931
(701) 234-4703
Mailing address
3838 12TH AVE N, FARGO, ND 58102-2931
(701) 234-4703
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1321
ND
225100000X
Physical Therapist
6950
MN
Other
Enumeration date
12/05/2011
Last updated
12/05/2011
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