Healthcare Provider Details

I. General information

NPI: 1871668939
Provider Name (Legal Business Name): LORI L BENNETT PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 MOUNTAIN RD NE ALBUQUERQUE PHYSICAL THERAPISTS
ALBUQUERQUE NM
87110-7805
US

IV. Provider business mailing address

522 HERMOSA DR SE
ALBUQUERQUE NM
87108
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-7979
  • Fax: 505-888-8859
Mailing address:
  • Phone: 505-268-9209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number705
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number705
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: