Provider Demographics
NPI:1861124349
Name:BENINATO, HEATHER JEAN (LMT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JEAN
Last Name:BENINATO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:JEAN
Other - Last Name:MALAHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:4425 E AGAVE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-0623
Mailing Address - Country:US
Mailing Address - Phone:602-400-5967
Mailing Address - Fax:480-269-9405
Practice Address - Street 1:4425 E AGAVE RD STE 150
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-0623
Practice Address - Country:US
Practice Address - Phone:602-400-5967
Practice Address - Fax:480-269-9405
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-13327225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty