Provider Demographics
NPI:1104583400
Name:BENNETT, TRUDY HODGES (PTA)
Entity type:Individual
Prefix:
First Name:TRUDY
Middle Name:HODGES
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 SPRINGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76087-3837
Mailing Address - Country:US
Mailing Address - Phone:817-455-1319
Mailing Address - Fax:
Practice Address - Street 1:401 W ARBROOK BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3108
Practice Address - Country:US
Practice Address - Phone:817-222-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-21
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2006094208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation