Provider Demographics
NPI:1144362096
Name:BENKO, GRETCHEN LEIGH
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:LEIGH
Last Name:BENKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 ROCK ST
Mailing Address - Street 2:APT 39
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94043-2660
Mailing Address - Country:US
Mailing Address - Phone:650-961-5979
Mailing Address - Fax:
Practice Address - Street 1:2310 ROCK ST
Practice Address - Street 2:APT 39
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-2660
Practice Address - Country:US
Practice Address - Phone:650-961-5979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT 007974-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6558OtherCOLORADO LICENSE NUMBER
CAPT 21423OtherCA PT LICENSE NUMBER
PAPT-007974-LOtherPHYSICAL THERAPY LICENSE