Individual
JASON EUGENE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT SCS ATC
Contact information
Practice address
3437 CAROLINE ST, SAINT LOUIS, MO 63104-1111
(314) 977-8652
Mailing address
502 LEONARD AVE, SAINT LOUIS, MO 63119-1538
(314) 459-4114
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
119668
MO
2255A2300X
Athletic Trainer
2008003299
MO
Other
Enumeration date
08/31/2006
Last updated
07/13/2012
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