Provider Demographics
NPI:1982627634
Name:BENNETT, LEE C III (MSPT)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:C
Last Name:BENNETT
Suffix:III
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOPE VALLEY
Mailing Address - State:RI
Mailing Address - Zip Code:02832-3405
Mailing Address - Country:US
Mailing Address - Phone:207-577-4891
Mailing Address - Fax:
Practice Address - Street 1:10 HIGH ST
Practice Address - Street 2:S. C. ORTHO - SUITE G
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3144
Practice Address - Country:US
Practice Address - Phone:401-783-8077
Practice Address - Fax:401-789-6029
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI412031OtherRI BLUE CHIP PIN