Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 0016110 | CO |
NPI | 1043782394 |
---|---|
Provider Name | Dana Bennink |
First Address | Niantic, CT 06357-1521 |
Second Address | Aurora, CO 80045-7106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2018 |
Last Update Date | 27/12/2018 |