MEDICARE: CAROLINE ANNE BENNETT REY 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
1	225100000X	Physical Therapist	6401	MN

General Provider Information

NPI Number	:	1538821764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE ANNE BENNETT REY PT

Provider Business Mailing Address
First Line	:	4200 DAHLBERG DR STE 300
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-4841
Country	:	US
Telephone Number	:	952-512-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 DAHLBERG DR STE 200
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-4841
Country	:	US
Telephone Number	:	952-512-5600
Fax Number	:	952-512-5651

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

Provider Enumeration Date	:	10/05/2021
Last Update Date	:	10/05/2021

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