Provider Demographics
NPI:1285757120
Name:BENDER, LAURA ANN (PT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:BENDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7061 W 1000 S
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:IN
Mailing Address - Zip Code:47612-8837
Mailing Address - Country:US
Mailing Address - Phone:812-455-9035
Mailing Address - Fax:
Practice Address - Street 1:555 TENNIS LN
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2613
Practice Address - Country:US
Practice Address - Phone:812-401-5210
Practice Address - Fax:812-401-5220
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003224A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN252940AMedicare PIN