Provider Demographics
NPI:1316428006
Name:BENNETT, MICHAEL KENNETH (PFT, CPT, CAPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KENNETH
Last Name:BENNETT
Suffix:
Gender:M
Credentials:PFT, CPT, CAPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1358 LEEGATE RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1301
Mailing Address - Country:US
Mailing Address - Phone:202-730-9300
Mailing Address - Fax:202-730-9301
Practice Address - Street 1:1358 LEEGATE RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1301
Practice Address - Country:US
Practice Address - Phone:202-730-9300
Practice Address - Fax:202-730-9301
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist