Provider Demographics
NPI:1417236357
Name:BENNETT, LENORA (LMT, MMP)
Entity Type:Individual
Prefix:MS
First Name:LENORA
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14949 W DAHLIA DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5944
Mailing Address - Country:US
Mailing Address - Phone:623-221-9367
Mailing Address - Fax:
Practice Address - Street 1:14949 W DAHLIA DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-5944
Practice Address - Country:US
Practice Address - Phone:623-221-9367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT12017225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist