Provider Demographics
NPI:1811272073
Name:BENNETT, LISA BETH (DPT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:BETH
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:BETH
Other - Last Name:BLATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10215 FERNWOOD RD
Mailing Address - Street 2:SUITE 506
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1106
Mailing Address - Country:US
Mailing Address - Phone:240-482-2414
Mailing Address - Fax:301-897-8597
Practice Address - Street 1:10215 FERNWOOD RD
Practice Address - Street 2:SUITE 211
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1106
Practice Address - Country:US
Practice Address - Phone:240-482-2438
Practice Address - Fax:301-530-3030
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD236802251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics