Provider Demographics
NPI:1811439854
Name:BRACKETT BENGE, KATHY (LMT)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:BRACKETT BENGE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BAUGHMAN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2399
Mailing Address - Country:US
Mailing Address - Phone:859-691-1119
Mailing Address - Fax:
Practice Address - Street 1:100 BAUGHMAN AVE.
Practice Address - Street 2:SUIT B
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422
Practice Address - Country:US
Practice Address - Phone:859-691-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2272225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist