Provider Demographics
NPI:1174216162
Name:BENNETT, LANA M (DPT)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:M
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 LONGMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8407
Mailing Address - Country:US
Mailing Address - Phone:617-905-7234
Mailing Address - Fax:
Practice Address - Street 1:39 LIMERICK RD
Practice Address - Street 2:
Practice Address - City:ARUNDEL
Practice Address - State:ME
Practice Address - Zip Code:04046-8158
Practice Address - Country:US
Practice Address - Phone:207-299-6395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3246225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist