Provider Demographics
NPI:1851077499
Name:BENNETT, HUNTER (DPT)
Entity Type:Individual
Prefix:
First Name:HUNTER
Middle Name:
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 1:9502 LIMA RD STE 103
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-9270
Mailing Address - Country:US
Mailing Address - Phone:260-459-7313
Mailing Address - Fax:260-436-0628
Practice Address - Street 1:9502 LIMA RD STE 103
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-9270
Practice Address - Country:US
Practice Address - Phone:260-459-7313
Practice Address - Fax:260-436-0628
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05014588A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist