Doctor Name: | TOM D BENNETCH |
NPI Number: | 1174638084 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | 4446 |
Business Practice Address: | 297 S Lake Havasu Ave #102 Lake Havasu City, AZ - 86403 |
Business Phone Number: | 9284530501 |
Business Fax Number: | 9284530502 |
Mailing Address: | 1990 Mcculloch Blvd N, #d282 LAKE HAVASU CITY |
State: | AZ |
Postal Code: | 864035749 |
Phone Number: | 9284530501 |
Fax Number: | |
NPI Enumeration Date: | 08/20/2006 |
NPI Last Update Date: | 08/30/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 4446 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |