Provider Demographics
NPI:1144252958
Name:BENAVIDEZ, DENISE A (MPT)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:A
Last Name:BENAVIDEZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 681478
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-1478
Mailing Address - Country:US
Mailing Address - Phone:866-800-9147
Mailing Address - Fax:615-591-6601
Practice Address - Street 1:1615 BLACKLSTON VIEW DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129
Practice Address - Country:US
Practice Address - Phone:812-288-8817
Practice Address - Fax:812-288-8837
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007842A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN187330GMedicare PIN
KY0717708Medicare PIN