MEDICARE: STEVEN CLARK BENNETT MSPT

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
1	225100000X	Physical Therapist	354321-2401	UT

General Provider Information

NPI Number	:	1205911872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN CLARK BENNETT MSPT

Provider Business Mailing Address
First Line	:	301 N 200 E
Second Line	:	#3E
City	:	ST GEORGE
State	:	UT
Zip	:	84770-3010
Country	:	US
Telephone Number	:	435-628-5194
Fax Number	:	435-628-5194

Provider Business Practice Location Address
First Line	:	301 N 200 E
Second Line	:	#3E
City	:	ST GEORGE
State	:	UT
Zip	:	84770-3010
Country	:	US
Telephone Number	:	435-628-5194
Fax Number	:	435-628-5194

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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Directions to “ STEVEN CLARK BENNETT MSPT” Practice Location

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