Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1098168 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1098168 | TX |
NPI | 1003975228 |
---|---|
Provider Name | Julia Elizabeth Bennett |
First Address | Robinson, TX 76706-7109 |
Second Address | Waco, TX 76710-7544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 19/11/2008 |