Healthcare Provider Details

I. General information

NPI: 1306279252
Provider Name (Legal Business Name): GERALD F. BENNETT PT, ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2016 MORSE AVE
SACRAMENTO CA
95825-2135
US

IV. Provider business mailing address

2858 JANET DR
WEST SACRAMENTO CA
95691-4210
US

V. Phone/Fax

Practice location:
  • Phone: 916-765-1737
  • Fax: 916-729-1611
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 40131
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: