Provider Demographics
NPI:1528588712
Name:RADER, BENNETT MICHAEL (DPT)
Entity Type:Individual
Prefix:
First Name:BENNETT
Middle Name:MICHAEL
Last Name:RADER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HUBERT DR
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-1447
Mailing Address - Country:US
Mailing Address - Phone:580-799-0706
Mailing Address - Fax:
Practice Address - Street 1:105 HUBERT DR
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-1447
Practice Address - Country:US
Practice Address - Phone:580-799-0706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist