Provider Demographics
NPI:1245223221
Name:BENNETT, JAMES GREGORY (PT, DSC, MS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GREGORY
Last Name:BENNETT
Suffix:
Gender:M
Credentials:PT, DSC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 ARYNESS DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-3045
Mailing Address - Country:US
Mailing Address - Phone:703-938-9220
Mailing Address - Fax:
Practice Address - Street 1:2208 ARYNESS DR
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22181-3045
Practice Address - Country:US
Practice Address - Phone:703-938-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist