Provider Demographics
NPI:1780398529
Name:BENNETHUM, MATTHEW ROBERT
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROBERT
Last Name:BENNETHUM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 WINDMILL RD
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-1614
Mailing Address - Country:US
Mailing Address - Phone:610-670-2100
Mailing Address - Fax:
Practice Address - Street 1:3000 WINDMILL RD
Practice Address - Street 2:
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-1614
Practice Address - Country:US
Practice Address - Phone:610-670-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist