Provider Demographics
NPI:1073023347
Name:BENNETT, STEVEN ALWYN (CMT/L)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALWYN
Last Name:BENNETT
Suffix:
Gender:M
Credentials:CMT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FIVE POINTS RD
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8526
Mailing Address - Country:US
Mailing Address - Phone:1215-679-6082
Mailing Address - Fax:
Practice Address - Street 1:5620 E. TEXAS RD.
Practice Address - Street 2:
Practice Address - City:EAST TEXAS (MACUNGIE)
Practice Address - State:PA
Practice Address - Zip Code:18046
Practice Address - Country:US
Practice Address - Phone:610-398-9773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG003670225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist