Provider Demographics
NPI:1194813329
Name:BENDER, BRUCE CHARLES (BS PT)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:CHARLES
Last Name:BENDER
Suffix:
Gender:M
Credentials:BS PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:380 S HILL ST
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-2229
Mailing Address - Country:US
Mailing Address - Phone:928-425-3538
Mailing Address - Fax:928-425-6808
Practice Address - Street 1:380 S HILL ST
Practice Address - Street 2:PINAL MOUNTAIN REHAB
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-2229
Practice Address - Country:US
Practice Address - Phone:928-425-3538
Practice Address - Fax:928-425-6808
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ0997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ60834Medicare ID - Type UnspecifiedPHYSICAL THERAPIST