Provider Demographics
NPI:1114371093
Name:BENNETT, THOMAS LOWELL (LAT/ATC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LOWELL
Last Name:BENNETT
Suffix:
Gender:M
Credentials:LAT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7675 BALTIMORE AVE
Mailing Address - Street 2:R 0100
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740
Mailing Address - Country:US
Mailing Address - Phone:301-405-5711
Mailing Address - Fax:
Practice Address - Street 1:7675 BALTIMORE AVE
Practice Address - Street 2:R 0100
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740
Practice Address - Country:US
Practice Address - Phone:301-405-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA004942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer