Provider Demographics
NPI:1306439732
Name:BENSEND, LAURITS MIKEL (CERT ADVANCED ROLFER)
Entity type:Individual
Prefix:
First Name:LAURITS
Middle Name:MIKEL
Last Name:BENSEND
Suffix:
Gender:M
Credentials:CERT ADVANCED ROLFER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 HARVESTER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1125
Mailing Address - Country:US
Mailing Address - Phone:203-216-9770
Mailing Address - Fax:
Practice Address - Street 1:1071 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5364
Practice Address - Country:US
Practice Address - Phone:203-216-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006454225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist