Healthcare Provider Details

I. General information

NPI: 1255833737
Provider Name (Legal Business Name): BENNETT GATTO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 KING AVE
COLUMBUS OH
43212-2220
US

IV. Provider business mailing address

PO BOX 911063
LEXINGTON KY
40591
US

V. Phone/Fax

Practice location:
  • Phone: 502-609-4289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007334
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP008679T
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: