Provider Demographics
NPI:1053428797
Name:BENNETT, ANDREW C (PT)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:BENNETT
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:1324 COMMON ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3565
Mailing Address - Country:US
Mailing Address - Phone:830-625-7310
Mailing Address - Fax:830-625-3228
Practice Address - Street 1:8335 AGORA PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-1382
Practice Address - Country:US
Practice Address - Phone:210-658-8483
Practice Address - Fax:210-658-0828
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2016-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX1131118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170506301Medicaid
TX8T2966OtherBC/BS
TX8T2966Medicare Oscar/Certification