MEDICARE: AMY BENNETT PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	06163	OH

General Provider Information

NPI Number	:	1659512689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY BENNETT PT

Provider Business Mailing Address
First Line	:	8087 WASHINGTON VILLAGE DR
Second Line	:	SUITE 101
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-1840
Country	:	US
Telephone Number	:	937-938-8380
Fax Number	:	937-938-8392

Provider Business Practice Location Address
First Line	:	8087 WASHINGTON VILLAGE DR
Second Line	:	SUITE 101
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-1840
Country	:	US
Telephone Number	:	937-938-8380
Fax Number	:	937-938-8392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2009
Last Update Date	:	03/07/2011

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Directions to “ AMY BENNETT PT” Practice Location

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