Provider Demographics
NPI:1306010996
Name:BENNETT, MARIA LAURISA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LAURISA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:LAURISA
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:55 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2826
Mailing Address - Country:US
Mailing Address - Phone:541-359-7142
Mailing Address - Fax:
Practice Address - Street 1:55 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404
Practice Address - Country:US
Practice Address - Phone:541-359-7142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT294703225100000X
OR62608225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist