Individual
TIMBER BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MMP
Contact information
Practice address
2633 STEPPINGTON ST, GRAND PRAIRIE, TX 75052-4003
(817) 805-4614
Mailing address
2633 STEPPINGTON ST, GRAND PRAIRIE, TX 75052-4003
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT124884
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT124884
ALL INSURANCES
TX
05
—
MT124884
—
TX
Enumeration date
11/11/2020
Last updated
11/11/2020
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