Provider Demographics
NPI:1184171092
Name:BENNETT, AIMEE (DPT)
Entity type:Individual
Prefix:
First Name:AIMEE
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 1:6495 SHILOH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-1635
Mailing Address - Country:US
Mailing Address - Phone:770-888-3011
Mailing Address - Fax:770-888-3227
Practice Address - Street 1:6495 SHILOH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-1635
Practice Address - Country:US
Practice Address - Phone:770-888-3011
Practice Address - Fax:770-888-3227
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT12458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist