Individual
DR. EDIE KNOWLTON BENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD.
Contact information
Practice address
4707 MILL STREET, MANTUA, OH 44255
(330) 274-2747
(330) 274-0337
Mailing address
PO BOX 638, MANTUA, OH 44255-0638
(330) 274-2747
(330) 274-0337
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3343
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2161922
—
OH
Enumeration date
11/16/2006
Last updated
09/06/2024
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