Healthcare Provider Details

I. General information

NPI: 1508775347
Provider Name (Legal Business Name): DANISHA BENNETT NMT, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 MAIN ST NW STE A
LILBURN GA
30047-5000
US

IV. Provider business mailing address

8735 DUNWOODY PL STE R
SANDY SPRINGS GA
30350-2995
US

V. Phone/Fax

Practice location:
  • Phone: 770-807-1588
  • Fax:
Mailing address:
  • Phone: 770-807-1588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT015859
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: