Provider Demographics
NPI:1053801274
Name:THE BENNETT ORGANIZATION LLC
Entity type:Organization
Organization Name:THE BENNETT ORGANIZATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LAURISA
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:541-359-7142
Mailing Address - Street 1:55 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2826
Mailing Address - Country:US
Mailing Address - Phone:541-359-7142
Mailing Address - Fax:
Practice Address - Street 1:55 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-2826
Practice Address - Country:US
Practice Address - Phone:541-359-7142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE BENNETT ORGANIZATION LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62608225100000X
CAPT294703225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty