Provider Demographics
NPI:1861817801
Name:BENNETT, LARRY II (DPT)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:BENNETT
Suffix:II
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 WINDSHIRE LN UNIT 210
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4190
Mailing Address - Country:US
Mailing Address - Phone:704-293-0202
Mailing Address - Fax:
Practice Address - Street 1:6697 VILLA CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2468
Practice Address - Country:US
Practice Address - Phone:704-293-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012203225100000X
TX1254338225100000X
MD24972225100000X
SC7282225100000X
NCP13484225100000X
NC13484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist