Healthcare Provider Details

I. General information

NPI: 1609189968
Provider Name (Legal Business Name): FRANK C BENNETT PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 OLD KINGS RD N STE K
PALM COAST FL
32137-8283
US

IV. Provider business mailing address

1075 MASON AVE
DAYTONA BEACH FL
32117-4611
US

V. Phone/Fax

Practice location:
  • Phone: 386-255-4596
  • Fax: 386-258-3561
Mailing address:
  • Phone: 386-255-4596
  • Fax: 386-258-3561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 8084
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: