Provider Demographics
NPI:1730368580
Name:BAMBENEK, MICHELL (PT)
Entity type:Individual
Prefix:
First Name:MICHELL
Middle Name:
Last Name:BAMBENEK
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 1:3930 S ALMA SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-4510
Mailing Address - Country:US
Mailing Address - Phone:480-899-9829
Mailing Address - Fax:480-726-9829
Practice Address - Street 1:3930 S ALMA SCHOOL RD
Practice Address - Street 2:STE 3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-4510
Practice Address - Country:US
Practice Address - Phone:480-988-9829
Practice Address - Fax:480-726-9829
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00600643OtherRAIL ROAD MEDICARE
AZP00600643Medicare PIN
AZP00600643OtherRAIL ROAD MEDICARE
AZ119113Medicare PIN