Provider Demographics
NPI:1386362564
Name:BENNETT, PAIGE MACKENZIE (BA)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:MACKENZIE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:MACKENZIE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:541 ANCIENT MAYAN DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-5918
Mailing Address - Country:US
Mailing Address - Phone:702-910-5821
Mailing Address - Fax:
Practice Address - Street 1:5412 BOULDER HWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-6039
Practice Address - Country:US
Practice Address - Phone:702-291-7121
Practice Address - Fax:702-507-2534
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner