=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447750682
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC MICHAEL BENDER PT,DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2018
-----------------------------------------------------
Last Update Date | 06/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7410 W WARREN CIR APT 1133
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80227-2697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-964-1270
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7410 W WARREN CIR APT 1133
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80227-2697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-964-1270
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 0015425
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------