Provider Demographics
NPI:1467706655
Name:ROBERT BENNER PT PA
Entity Type:Organization
Organization Name:ROBERT BENNER PT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:207-465-4601
Mailing Address - Street 1:PO BOX 1744
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04903-1744
Mailing Address - Country:US
Mailing Address - Phone:207-465-4601
Mailing Address - Fax:207-465-4602
Practice Address - Street 1:895 KENNEDY MEMORIAL DR
Practice Address - Street 2:UNIT 3
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-4874
Practice Address - Country:US
Practice Address - Phone:207-465-4601
Practice Address - Fax:207-465-4602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty