Healthcare Provider Details

I. General information

NPI: 1942789383
Provider Name (Legal Business Name): AUBREY LOUISE BENNETT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W JACKSON ST STE 2
RIDGELAND MS
39157-2355
US

IV. Provider business mailing address

207 W JACKSON ST STE 2
RIDGELAND MS
39157-2355
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-0859
  • Fax: 601-362-0870
Mailing address:
  • Phone: 601-362-0859
  • Fax: 601-362-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH8993
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT-7078
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: