Provider Demographics
NPI:1447316229
Name:BENDER, DEWALT DAVID (PT)
Entity type:Individual
Prefix:MR
First Name:DEWALT
Middle Name:DAVID
Last Name:BENDER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11350 EXECUTIVE PLAZA IV RD STE LL12
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-8997
Mailing Address - Country:US
Mailing Address - Phone:443-213-0395
Mailing Address - Fax:443-973-6125
Practice Address - Street 1:1420 CLARKVIEW RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2104
Practice Address - Country:US
Practice Address - Phone:443-213-0395
Practice Address - Fax:443-973-6125
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist