Provider Demographics
NPI:1851026496
Name:BENNETT, MARY KATHRYN FREY (DPT)
Entity Type:Individual
Prefix:
First Name:MARY KATHRYN
Middle Name:FREY
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 NICOLIN RD
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-3113
Mailing Address - Country:US
Mailing Address - Phone:774-200-5090
Mailing Address - Fax:
Practice Address - Street 1:94 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1340
Practice Address - Country:US
Practice Address - Phone:207-839-5860
Practice Address - Fax:207-839-2499
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0160162251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics