Provider Demographics
NPI:1871284471
Name:BENNETT, TORY LEE
Entity type:Individual
Prefix:
First Name:TORY
Middle Name:LEE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 N WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1548
Mailing Address - Country:US
Mailing Address - Phone:989-906-7367
Mailing Address - Fax:
Practice Address - Street 1:128 N WARREN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48607-1548
Practice Address - Country:US
Practice Address - Phone:989-906-7367
Practice Address - Fax:989-754-5154
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist