Provider Demographics
NPI:1740238724
Name:BENNETT, DEANNA M (ATC)
Entity Type:Individual
Prefix:MISS
First Name:DEANNA
Middle Name:M
Last Name:BENNETT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 HOWARDS LOOP
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-8740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:0610 TERRAPIN TRAIL
Practice Address - Street 2:UNIVERSITY OF MARYLAND
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20741-0295
Practice Address - Country:US
Practice Address - Phone:301-314-7137
Practice Address - Fax:301-314-9439
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer