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General NPI Number Information
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NPI Number | 1811272073
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Entity Type | Individual
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Provider Name | LISA BETH BENNETT DPT
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Gender | Female
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 10215 FERNWOOD RD SUITE 211
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City | BETHESDA
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State | MD
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Zip | 20817-1106
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Country | US
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Telephone | 240-482-2438
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Fax | 301-530-3030
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Provider Business Mailing Address
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Address Line | 10215 FERNWOOD RD SUITE 506
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City | BETHESDA
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State | MD
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Zip | 20817-1106
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Country | US
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Telephone | 240-482-2414
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Fax | 301-897-8597
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 23680
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License Number State | MD
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