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NPI Code Detail

MEDICARE: DAVID THOMAS BENNETT

MEDICARE: DAVID THOMAS BENNETT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation PractitionerCDCA.165994OH

General Provider Information

NPI Number : 1154818649
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID THOMAS BENNETT
Provider Business Mailing Address
First Line : 110 HIGHLAND AVE
Second Line :
City : CIRCLEVILLE
State : OH
Zip : 43113-1208
Country : US
Telephone Number : 740-477-1745
Fax Number : 740-477-2779
Provider Business Practice Location Address
First Line : 110 HIGHLAND AVE
Second Line :
City : CIRCLEVILLE
State : OH
Zip : 43113-1208
Country : US
Telephone Number : 740-215-8024
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2018
Last Update Date : 04/19/2018

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