Provider Demographics
NPI:1699345207
Name:BENCH, ALEX EARL (LMT)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:EARL
Last Name:BENCH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:SONNY
Other - Middle Name:ALEXANDER
Other - Last Name:LORRIUS
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 ELLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2758
Mailing Address - Country:US
Mailing Address - Phone:407-462-2514
Mailing Address - Fax:
Practice Address - Street 1:1540 INTERNATIONAL PKWY STE 2000
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5096
Practice Address - Country:US
Practice Address - Phone:407-305-6993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL92421225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist