Provider Demographics
NPI:1801184080
Name:BENDER, LARRA JEAN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LARRA
Middle Name:JEAN
Last Name:BENDER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:LARRA
Other - Middle Name:JEAN
Other - Last Name:QUANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:1405 N. PIERCE ST. SUITE 210
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207
Mailing Address - Country:US
Mailing Address - Phone:501-664-6664
Mailing Address - Fax:501-664-6614
Practice Address - Street 1:1405 N. PIERCE ST. SUITE 210
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207
Practice Address - Country:US
Practice Address - Phone:501-664-6664
Practice Address - Fax:501-664-6614
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7302225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist