Healthcare Provider Details

I. General information

NPI: 1437644820
Provider Name (Legal Business Name): SUSAN PV BENNETT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 S MAIN ST
CHELSEA MI
48118-1383
US

IV. Provider business mailing address

775 S MAIN ST
CHELSEA MI
48118-1383
US

V. Phone/Fax

Practice location:
  • Phone: 734-593-5600
  • Fax:
Mailing address:
  • Phone: 734-593-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501002144
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: