Individual
JEREMY A BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4051
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00237896
—
MS
01
—
0463784
CIGNA
MS
01
—
3451245
UNITED HEALTHCARE
MS
01
—
9007864
AETNA
MS
01
—
P01206663
RAILROAD MEDICARE
MS
Enumeration date
11/02/2010
Last updated
08/23/2016
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