Provider Demographics
NPI:1346526738
Name:BENNETT, KATHERINE D (LMT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:D
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:D
Other - Last Name:BILLITER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:734 BIG TREE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-2754
Mailing Address - Country:US
Mailing Address - Phone:386-334-6612
Mailing Address - Fax:
Practice Address - Street 1:734 BIG TREE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-2754
Practice Address - Country:US
Practice Address - Phone:386-334-6612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-29
Last Update Date:2011-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0022040225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist