| Organization Name: | BENNETT CLINIC LLC |
| NPI Number: | 1104167444 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY EVELYN BENNETT (PARTNER) |
| Mailing Address: | 7876 E Florentine Rd Prescott Valley |
| State: | AZ US |
| Postal Code: | 863142216 |
| Phone Number: | 9287727200 |
| Fax Number: | 9287727779 |
| NPI Enumeration Date: | 03/12/2013 |
| NPI Last Update Date: | 03/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | PT 6078 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |