Basic Information
| Provider Information | |||||||||
| NPI: | 1053428797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNETT | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1324 COMMON ST | ||||||||
| Address2: | SUITE 307 | ||||||||
| City: | NEW BRAUNFELS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781303565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306257310 | ||||||||
| FaxNumber: | 8306253228 | ||||||||
| Practice Location | |||||||||
| Address1: | 8335 AGORA PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SELMA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781541382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106588483 | ||||||||
| FaxNumber: | 2106580828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 10/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1131118 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 170506301 | 05 | TX | MEDICAID | 8T2966 | 01 | TX | BC/BS | OTHER |