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General NPI Number Information
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NPI Number | 1942789383
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Entity Type | Individual
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Provider Name | AUBREY LOUISE BENNETT PT
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Gender | Female
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 207 W JACKSON ST STE 2
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City | RIDGELAND
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State | MS
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Zip | 39157-2355
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Country | US
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Telephone | 601-362-0859
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Fax | 601-362-0870
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Provider Business Mailing Address
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Address Line | 207 W JACKSON ST STE 2
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City | RIDGELAND
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State | MS
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Zip | 39157-2355
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Country | US
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Telephone | 601-362-0859
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Fax | 601-362-0870
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTH8993
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT-7078
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License Number State | MS
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