Provider Demographics
NPI:1598308884
Name:BENNETT PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:BENNETT PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:985-607-8155
Mailing Address - Street 1:37197 PINE STREET EXT
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-5271
Mailing Address - Country:US
Mailing Address - Phone:985-607-8155
Mailing Address - Fax:
Practice Address - Street 1:64167 HIGHWAY 41 STE C
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:LA
Practice Address - Zip Code:70452-3638
Practice Address - Country:US
Practice Address - Phone:985-607-8155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-20
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy