Provider Demographics
NPI:1053027219
Name:BENNETT, GAIL KATHRYN (PT)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:KATHRYN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ARBUTUS DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55810-1935
Mailing Address - Country:US
Mailing Address - Phone:218-750-0366
Mailing Address - Fax:
Practice Address - Street 1:23 ARBUTUS DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55810-1935
Practice Address - Country:US
Practice Address - Phone:218-750-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5352208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation