Provider Demographics
NPI:1295615649
Name:BENNETT, DANIELLE (LMT)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 MCCULLOCH BLVD N # 393
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-0961
Mailing Address - Country:US
Mailing Address - Phone:928-706-2121
Mailing Address - Fax:
Practice Address - Street 1:1695 MESQUITE AVE STE 114
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5687
Practice Address - Country:US
Practice Address - Phone:928-453-6808
Practice Address - Fax:928-453-8485
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-27432225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist