| Bennett Clinic Llc | |
|
1202 Willow Creek Rd, Prescott, AZ 86301-1428 | |
| (928) 771-9400 | |
| (928) 771-9464 |
| Full Name | Bennett Clinic Llc |
|---|---|
| Type | Facility |
| Speciality | Clinic/center - Physical Therapy |
| Location | 1202 Willow Creek Rd, Prescott, Arizona |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083946586 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111NX0800X | Chiropractor - Orthopedic | 5009 (Arizona) | Secondary |
| 261QP2000X | Clinic/center - Physical Therapy | PT 6078 (Arizona) | Primary |
| Provider Name | Wayne A Bennett |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1952386542 PECOS PAC ID: 1254373988 Enrollment ID: I20050524000270 |
| Provider Name | Michael B Nash |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1184609786 PECOS PAC ID: 6002858289 Enrollment ID: I20050527000089 |
| Provider Name | Janelle H Goligoski |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1033163860 PECOS PAC ID: 8325094402 Enrollment ID: I20051109000617 |
| Provider Name | Travis Jordan Wetzel |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1114462157 PECOS PAC ID: 0941577720 Enrollment ID: I20170526001039 |
| Provider Name | Sean Moran |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1154466860 PECOS PAC ID: 4082656319 Enrollment ID: I20190610001726 |
| Mailing Address | Practice Location Address |
|---|---|
| Bennett Clinic Llc 1202 Willow Creek Rd, Prescott, AZ 86301-1428 Ph: (928) 771-9400 | Bennett Clinic Llc 1202 Willow Creek Rd, Prescott, AZ 86301-1428 Ph: (928) 771-9400 |