Doctor Name: | AMANDA BENNETT |
NPI Number: | 1962867838 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ATC, LAT, PES, EMT-B |
License Number: | AL3539 |
Business Practice Address: | 705 Central Parke Cir Apt 208 Lakeland, FL - 338059590 |
Business Phone Number: | 8655569589 |
Business Fax Number: | |
Mailing Address: | 705 Central Parke Cir Apt 208, LAKELAND |
State: | FL |
Postal Code: | 338059590 |
Phone Number: | 8655569589 |
Fax Number: | |
NPI Enumeration Date: | 12/21/2015 |
NPI Last Update Date: | 12/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | AL3539 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |