MEDICARE: HUNTER BENNETT DPT

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	05014588A	IN

General Provider Information

NPI Number	:	1851077499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUNTER BENNETT DPT

Provider Business Mailing Address
First Line	:	9502 LIMA RD STE 103
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-9270
Country	:	US
Telephone Number	:	260-459-7313
Fax Number	:	260-436-0628

Provider Business Practice Location Address
First Line	:	9502 LIMA RD STE 103
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-9270
Country	:	US
Telephone Number	:	260-459-7313
Fax Number	:	260-436-0628

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

Provider Enumeration Date	:	06/27/2023
Last Update Date	:	06/27/2023

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Directions to “ HUNTER BENNETT DPT” Practice Location

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