Provider Demographics
NPI:1578866166
Name:BENNETT, STACY LYNN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:LYNN
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3342 COMMODORE DR
Mailing Address - Street 2:APT. 471
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-3606
Mailing Address - Country:US
Mailing Address - Phone:859-699-6222
Mailing Address - Fax:
Practice Address - Street 1:13201 MAGISTERIAL DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4105
Practice Address - Country:US
Practice Address - Phone:502-244-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37349225100000X
KY0062692251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist