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General NPI Number Information
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NPI Number | 1073023347
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Entity Type | Individual
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Provider Name | STEVEN ALWYN BENNETT CMT/L
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Gender | Male
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 10/02/2017
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Provider Practice Location Address
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Address Line | 5620 E. TEXAS RD.
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City | EAST TEXAS (MACUNGIE)
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State | PA
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Zip | 18046
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Country | US
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Telephone | 610-398-9773
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Fax |
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Provider Business Mailing Address
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Address Line | 14 FIVE POINTS RD
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City | MACUNGIE
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State | PA
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Zip | 18062-8526
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Country | US
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Telephone | 12156796082
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MSG003670
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License Number State | PA
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