Provider Demographics
NPI:1003508045
Name:BENNETT, AUSTIN H (DPT)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:H
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2653
Mailing Address - Country:US
Mailing Address - Phone:434-851-0091
Mailing Address - Fax:
Practice Address - Street 1:2011 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2653
Practice Address - Country:US
Practice Address - Phone:434-851-0091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist