Provider Demographics
NPI:1295741445
Name:BENNETT, CRAIG ALLEN (ATC)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:ALLEN
Last Name:BENNETT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 32ND AVENUE CT SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2094
Mailing Address - Country:US
Mailing Address - Phone:253-879-3441
Mailing Address - Fax:253-879-3634
Practice Address - Street 1:1500 N. WARNER ST. #1044
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98416
Practice Address - Country:US
Practice Address - Phone:253-879-3441
Practice Address - Fax:253-879-3634
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer