| NPI | 1699717595 |
|---|---|
| Former Name | LISA MARIE BENNETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MT 11366) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MT MT1136) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2017-08-08 |