Provider Demographics
NPI:1295150696
Name:AMN
Entity type:Organization
Organization Name:AMN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:II
Authorized Official - Credentials:DPT
Authorized Official - Phone:704-293-0202
Mailing Address - Street 1:3015 RIVER CHASE DR. APT. W
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120
Mailing Address - Country:US
Mailing Address - Phone:704-293-0202
Mailing Address - Fax:
Practice Address - Street 1:2810 16TH ST NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-9600
Practice Address - Country:US
Practice Address - Phone:888-367-0318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-22
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC13484261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy