Provider Demographics
NPI:1770605875
Name:BENDER, KEVIN STUART (ATC)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:STUART
Last Name:BENDER
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 1:636 BEN BOW DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-2465
Mailing Address - Country:US
Mailing Address - Phone:757-961-8948
Mailing Address - Fax:
Practice Address - Street 1:201 E BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2411
Practice Address - Country:US
Practice Address - Phone:757-640-1212
Practice Address - Fax:757-627-2795
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260000442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer