Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 05000616A | IN |
NPI | 1053580399 |
---|---|
Provider Name | Ms. Mary Louise Bennett |
First Address | Evansville, IN 47715-5052 |
Second Address | Evansville, IN 47715-5052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2008 |
Last Update Date | 20/02/2008 |