Provider Demographics
NPI:1982433488
Name:RACK, BENNETT JAMES
Entity type:Individual
Prefix:
First Name:BENNETT
Middle Name:JAMES
Last Name:RACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11203 RANCH ROAD 2222 APT 2403
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1033
Mailing Address - Country:US
Mailing Address - Phone:225-223-9585
Mailing Address - Fax:
Practice Address - Street 1:4201 BEE CAVES RD STE B106
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6458
Practice Address - Country:US
Practice Address - Phone:512-985-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3133027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist