Provider Demographics
NPI:1275979882
Name:BENNETT, SARAH WHITNEY (PT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:WHITNEY
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 1:10 BITTERSWEET DR
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1652
Mailing Address - Country:US
Mailing Address - Phone:860-389-1172
Mailing Address - Fax:
Practice Address - Street 1:31 VAUXHALL ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5723
Practice Address - Country:US
Practice Address - Phone:860-442-4363
Practice Address - Fax:860-447-3749
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist