Provider Demographics
NPI:1922148287
Name:BIENVENU, JOHN MICHAEL
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:BIENVENU
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 1:651 MAIN ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-2789
Mailing Address - Country:US
Mailing Address - Phone:205-608-3113
Mailing Address - Fax:205-608-3036
Practice Address - Street 1:651 MAIN ST
Practice Address - Street 2:SUITE 115
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2789
Practice Address - Country:US
Practice Address - Phone:205-608-3113
Practice Address - Fax:205-608-3036
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT07090225100000X
ALPTH5309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist