Individual
DEZHANE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
444 MERRICK RD # 360, LYNBROOK, NY 11563-2460
(516) 536-3800
Mailing address
12 ROOSEVELT AVE, AMITYVILLE, NY 11701-2317
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0134575-01
NY
Other
Enumeration date
12/08/2022
Last updated
12/08/2022
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