Provider Demographics
NPI:1588287726
Name:BENNER, TAWNEE (LMT)
Entity type:Individual
Prefix:
First Name:TAWNEE
Middle Name:
Last Name:BENNER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:ROCHEPORT
Mailing Address - State:MO
Mailing Address - Zip Code:65279-0045
Mailing Address - Country:US
Mailing Address - Phone:573-489-6383
Mailing Address - Fax:
Practice Address - Street 1:97 PIKE ST
Practice Address - Street 2:
Practice Address - City:ROCHEPORT
Practice Address - State:MO
Practice Address - Zip Code:65279-9392
Practice Address - Country:US
Practice Address - Phone:573-489-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018041781172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist