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Individual

MATTHEW BENNETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
6818 AUSTIN CENTER BLVD STE 111, AUSTIN, TX 78731-3199
(512) 418-8870
Mailing address
6607 BRODIE LN APT 1223, AUSTIN, TX 78745-4655
(512) 538-5352

Taxonomy

Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
1242529
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
124529
TEXAS PT LICENSE
TX
Enumeration date
06/11/2014
Last updated
06/11/2014
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