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Individual

MRS. JOAN KAREN BENNETT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT, MMP

Contact information

Practice address
2500 OLD ALABAMA RD, SUITE 24, ROSWELL, GA 30076-2400
(770) 998-9009
(770) 998-9701
Mailing address
2500 OLD ALABAMA ROAD, SUITE 24, ROSWELL, GA 30076-2400
(770) 998-9009
(770) 998-9071

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT000957
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
MT000957
MASSAGE THERAPY
GA
Enumeration date
09/03/2008
Last updated
09/03/2008
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