Provider Demographics
NPI:1508825670
Name:BENDER, ELIZABETH COPLIN (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:COPLIN
Last Name:BENDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4743 VINETA AVE
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2620
Mailing Address - Country:US
Mailing Address - Phone:818-790-6470
Mailing Address - Fax:
Practice Address - Street 1:650 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3429
Practice Address - Country:US
Practice Address - Phone:818-952-0906
Practice Address - Fax:818-952-0906
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist