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NPI Code Detail

MEDICARE: RENEE BENNETT PT

MEDICARE: RENEE BENNETT PT
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
1225100000XPhysical Therapist807AR
22251P0200XPediatric Physical Therapist807AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15T180OTHERARBCBS

General Provider Information

NPI Number : 1487702759
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENEE BENNETT PT
Provider Business Mailing Address
First Line : 10618 BRECKENRIDGE DR
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72211-1802
Country : US
Telephone Number : 501-217-8600
Fax Number : 501-217-8636
Provider Business Practice Location Address
First Line : 10618 BRECKENRIDGE DR
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72211-1802
Country : US
Telephone Number : 501-217-8600
Fax Number : 501-217-8636
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2007
Last Update Date : 09/11/2025

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