Provider Demographics
NPI:1750629838
Name:BENNETT, DANIEL ERIC
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:ERIC
Last Name:BENNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 NIRK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-5624
Mailing Address - Country:US
Mailing Address - Phone:314-583-9033
Mailing Address - Fax:
Practice Address - Street 1:202 S. MAIN ST
Practice Address - Street 2:
Practice Address - City:WATTS
Practice Address - State:OK
Practice Address - Zip Code:74964
Practice Address - Country:US
Practice Address - Phone:918-422-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner