Individual
MRS. DENISE DIANE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
789 JUSTIN RD, ROCKWALL, TX 75087-4840
(972) 771-5731
(972) 771-5786
Mailing address
3121 CARIBOU CT, MESQUITE, TX 75181-3660
(972) 222-2216
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1045052
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0094LV
BLUE CROSS BLUE SHIELD
TX
01
—
8T3239
BLUE CROSS BLUE SHIELD
TX
Enumeration date
10/25/2006
Last updated
07/08/2007
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