Provider Demographics
NPI:1720094634
Name:BENNETT, CHRISTOPHER EARL (MPT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EARL
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4972 BENCHMARK CENTRE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2070
Mailing Address - Country:US
Mailing Address - Phone:618-622-0303
Mailing Address - Fax:618-622-0909
Practice Address - Street 1:4972 BENCHMARK CENTRE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2070
Practice Address - Country:US
Practice Address - Phone:618-622-0303
Practice Address - Fax:618-622-0909
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005005711225100000X, 2251X0800X
IL070016895225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic