Provider Demographics
NPI:1205172731
Name:BENNETT, CHRISTY
Entity type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4945 CHELTENHAM PL
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5818
Mailing Address - Country:US
Mailing Address - Phone:770-601-8446
Mailing Address - Fax:770-889-5584
Practice Address - Street 1:4080 MCGINNIS FERRY RD
Practice Address - Street 2:BLDG.300, STE.302
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3948
Practice Address - Country:US
Practice Address - Phone:770-410-7719
Practice Address - Fax:770-889-5584
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002993225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation