Active NPI
Karen L. Bennett, PT
- Physical Therapist
- Tucker, GA
National Provider Identifier
1245395359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2144
- Practice address
- 3760 Lavista Rd
Suite 102
Tucker, GA 30084-5615 - Phone
- (404) 248-0415
- Fax
- (404) 248-0422
- NPI assigned
- Dec 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2144 | GA | Primary |
Addresses
Primary practice location
3760 Lavista Rd
Suite 102
Tucker, GA 30084-5615
Mailing address
3760 Lavista Rd
Suite 102
Tucker, GA 30084-5615
Phone (404) 248-0415
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00586902C | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2144 | GA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245395359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3760 LAVISTA RD",
"address_2": "SUITE 102",
"city": "TUCKER",
"state": "GA",
"postal_code": "300845615",
"telephone_number": "404-248-0415",
"fax_number": "404-248-0422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3760 LAVISTA RD",
"address_2": "SUITE 102",
"city": "TUCKER",
"state": "GA",
"postal_code": "300845615",
"telephone_number": "404-248-0415",
"fax_number": "404-248-0422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "KAREN",
"middle_name": "L.",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "2144",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00586902C",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.