Provider Demographics
NPI:1285891408
Name:BENNETT, SARAH TEEL (DPT, WCS, BCB-PMB)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:TEEL
Last Name:BENNETT
Suffix:
Gender:F
Credentials:DPT, WCS, BCB-PMB
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:TEEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:P.O. BOX 7187
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-2187
Mailing Address - Country:US
Mailing Address - Phone:910-238-2259
Mailing Address - Fax:888-209-9322
Practice Address - Street 1:233 BELL FORK RD.
Practice Address - Street 2:SUITE E
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6471
Practice Address - Country:US
Practice Address - Phone:910-238-2259
Practice Address - Fax:888-209-9322
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11244225100000X
NC225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ46230B725Medicare PIN