Provider Demographics
NPI:1043572274
Name:BENNETT, AMY TODD (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:TODD
Last Name:BENNETT
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:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:EAST NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21631-0025
Mailing Address - Country:US
Mailing Address - Phone:443-521-7040
Mailing Address - Fax:
Practice Address - Street 1:211 MANNING LANE
Practice Address - Street 2:PO BOX 25
Practice Address - City:EAST NEW MARKET
Practice Address - State:MD
Practice Address - Zip Code:21631
Practice Address - Country:US
Practice Address - Phone:443-521-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist