Healthcare Provider Details

I. General information

NPI: 1659879054
Provider Name (Legal Business Name): KRISTEN BENNETT PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 N COOPER RD
GILBERT AZ
85233-1234
US

IV. Provider business mailing address

15410 S MOUNTAIN PKWY STE 112
PHOENIX AZ
85044-6691
US

V. Phone/Fax

Practice location:
  • Phone: 480-505-8140
  • Fax: 480-505-8145
Mailing address:
  • Phone: 480-706-1161
  • Fax: 480-706-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13607
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: