Provider Demographics
NPI:1366875551
Name:BENNETT, SAMANTHA (DPT)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
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 1:130 ADMIRAL COCHRANE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7368
Mailing Address - Country:US
Mailing Address - Phone:410-266-1500
Mailing Address - Fax:410-266-1369
Practice Address - Street 1:130 ADMIRAL COCHRANE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7368
Practice Address - Country:US
Practice Address - Phone:410-266-1500
Practice Address - Fax:410-266-1369
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist