Provider Demographics
NPI:1992081731
Name:BENNALLEY, TONI L (LAC)
Entity type:Individual
Prefix:MISS
First Name:TONI
Middle Name:L
Last Name:BENNALLEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:
Other - Last Name:BENNALLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSAC
Mailing Address - Street 1:6527 N 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-3541
Mailing Address - Country:US
Mailing Address - Phone:623-204-5604
Mailing Address - Fax:
Practice Address - Street 1:3030 N LITCHFIELD RD STE 120
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7803
Practice Address - Country:US
Practice Address - Phone:623-777-4555
Practice Address - Fax:623-242-5755
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ270171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist