Doctor Name: | MRS. JETTA MELINDA BENNER |
NPI Number: | 1073581609 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT |
License Number: | 1106805 |
Business Practice Address: | 638 Uptown Blvd Suite 1105 Cedar Hill, TX - 751043507 |
Business Phone Number: | 4692723129 |
Business Fax Number: | 4692723145 |
Mailing Address: | 638 Uptown Blvd, Suite 1105 CEDAR HILL |
State: | TX |
Postal Code: | 751043507 |
Phone Number: | 4692723129 |
Fax Number: | 4692723145 |
NPI Enumeration Date: | 03/09/2006 |
NPI Last Update Date: | 01/23/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | 1106805 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |