Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | MD00048553 | WA |
Y | 225400000X | Rehabilitation Practitioner | 41710 | CO |
NPI | 1063491199 |
---|---|
Provider Name | Dr. Cynthia Elaine Bennett |
First Address | Colorado Spgs, CO 80907-6868 |
Second Address | Colorado Spgs, CO 80907-6868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 24/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5160BE | BLUE SHIELD VM (01) | WA |
80031064 | (05) | CO |
8493199 | (05) | WA |
H23849 | (02) | CO |