Individual
BENNETT LAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
30141 ANTELOPE RD, SUITE A, MENIFEE, CA 92584-7001
(951) 723-1866
(951) 723-1867
Mailing address
24630 WASHINGTON AVE, SUITE 200, MURRIETA, CA 92562-6131
(951) 696-9353
(951) 973-7216
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40818
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA112199
MEDICARE PTAN
CA
Enumeration date
12/09/2013
Last updated
02/25/2014
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