Individual
MR. KAREN L. BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3760 LAVISTA RD, SUITE 102, TUCKER, GA 30084-5615
(404) 248-0415
(404) 248-0422
Mailing address
3760 LAVISTA RD, SUITE 102, TUCKER, GA 30084-5615
(404) 248-0415
(404) 248-0422
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2144
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00586902C
—
GA
Enumeration date
12/27/2006
Last updated
07/08/2007
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