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General NPI Number Information
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NPI Number | 1063491199
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Entity Type | Individual
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Provider Name | CYNTHIA ELAINE BENNETT M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 2222 N NEVADA AVE STE 5020
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City | COLORADO SPGS
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State | CO
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Zip | 80907-6868
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Country | US
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Telephone | 719-776-5960
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Fax | 719-776-5045
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Provider Business Mailing Address
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Address Line | 2222 N NEVADA AVE STE 5020
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City | COLORADO SPGS
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State | CO
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Zip | 80907-6868
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Country | US
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Telephone | 719-776-5960
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Fax | 719-776-5045
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 41710
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | MD00048553
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License Number State | WA
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