Individual
AMANDA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT, PES, EMT-B
Contact information
Practice address
705 CENTRAL PARKE CIR APT 208, LAKELAND, FL 33805-9590
(865) 556-9589
Mailing address
705 CENTRAL PARKE CIR APT 208, LAKELAND, FL 33805-9590
(865) 556-9589
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
AL3539
FL
Other
Enumeration date
12/21/2015
Last updated
12/21/2015
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