Provider Demographics
NPI:1033683222
Name:BENNETT, JESSICA LEIGH (MS, LAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEIGH
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LAT, ATC
Mailing Address - Street 1:42 BLUEBIRD LN
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36870-4755
Mailing Address - Country:US
Mailing Address - Phone:386-855-4826
Mailing Address - Fax:
Practice Address - Street 1:42 BLUEBIRD LN
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36870-4755
Practice Address - Country:US
Practice Address - Phone:386-855-4826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0036822255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer