MEDICARE: MICHELL BAMBENEK PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	7824	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00600643	OTHER	AZ	RAIL ROAD MEDICARE

General Provider Information

NPI Number	:	1730368580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELL BAMBENEK PT

Provider Business Mailing Address
First Line	:	3930 S ALMA SCHOOL RD
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85248-4510
Country	:	US
Telephone Number	:	480-899-9829
Fax Number	:	480-726-9829

Provider Business Practice Location Address
First Line	:	3930 S ALMA SCHOOL RD
Second Line	:	STE 3
City	:	CHANDLER
State	:	AZ
Zip	:	85248-4510
Country	:	US
Telephone Number	:	480-988-9829
Fax Number	:	480-726-9829

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	11/22/2016

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Directions to “ MICHELL BAMBENEK PT” Practice Location

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