Provider Demographics
NPI:1407497399
Name:BENNETT, ANTHONY (PTA)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BENNETT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 KENSINGTON PL APT G
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2295
Mailing Address - Country:US
Mailing Address - Phone:828-713-9538
Mailing Address - Fax:
Practice Address - Street 1:100 SILVER BLUFF DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716-6350
Practice Address - Country:US
Practice Address - Phone:828-648-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA6875225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant