Provider Demographics
NPI:1275685034
Name:BENETTI, ANNE (DPT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:BENETTI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:HIVALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:616 ADMIRAL DR
Mailing Address - Street 2:APT. 349
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2173
Mailing Address - Country:US
Mailing Address - Phone:410-562-7015
Mailing Address - Fax:
Practice Address - Street 1:3179 BRAVERTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2665
Practice Address - Country:US
Practice Address - Phone:410-956-4308
Practice Address - Fax:410-956-8038
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist