Provider Demographics
NPI:1841025806
Name:BENNETT, JOSHUA WALTER (PT, DPT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:WALTER
Last Name:BENNETT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 BOGHT RD
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-1105
Mailing Address - Country:US
Mailing Address - Phone:518-225-0904
Mailing Address - Fax:
Practice Address - Street 1:3106 S W S YOUNG DR STE A102
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2000
Practice Address - Country:US
Practice Address - Phone:254-628-8391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-07
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27956225100000X
NY052527225100000X
TX1403051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist