Healthcare Provider Details

I. General information

NPI: 1063491199
Provider Name (Legal Business Name): CYNTHIA ELAINE BENNETT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE STE 5020
COLORADO SPGS CO
80907-6868
US

IV. Provider business mailing address

2222 N NEVADA AVE STE 5020
COLORADO SPGS CO
80907-6868
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-5960
  • Fax: 719-776-5045
Mailing address:
  • Phone: 719-776-5960
  • Fax: 719-776-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number41710
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberMD00048553
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: