Provider Demographics
NPI:1760403380
Name:BENNETT, RACHEL MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:CLIFFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48727-9521
Mailing Address - Country:US
Mailing Address - Phone:989-761-7766
Mailing Address - Fax:
Practice Address - Street 1:6711 SMITH RD
Practice Address - Street 2:
Practice Address - City:CLIFFORD
Practice Address - State:MI
Practice Address - Zip Code:48727-9521
Practice Address - Country:US
Practice Address - Phone:989-761-7766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer