Provider Demographics
NPI:1871570077
Name:BENNETT, LINDA S (MPT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6019 OLEANDER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4796
Mailing Address - Country:US
Mailing Address - Phone:910-791-0001
Mailing Address - Fax:910-791-6888
Practice Address - Street 1:6019 OLEANDER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4796
Practice Address - Country:US
Practice Address - Phone:910-791-0001
Practice Address - Fax:910-791-6888
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4495020001OtherDME MEDICARE
NC7212104Medicaid
NC0784POtherBCBS GROUP
NC720784POtherMEDICAID GROUP
NC7200002OtherMEDICAID GROUP
NC2503655OtherMEDICARE GROUP
NCDF4857OtherRR MEDICARE GROUP
NC0671FOtherBCBS ID
NC2509457OtherMEDICARE ID
NCP00369642OtherRR MEDICARE PIN