Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501002903 | MI |
N | 2251G0304X | Physical Therapist - Geriatrics | 5501002903 | MI |
N | 2251N0400X | Physical Therapist - Neurology | 5501002903 | MI |
N | 2251P0200X | Physical Therapist - Pediatrics | 5501002903 | MI |
N | 2251X0800X | Physical Therapist - Orthopedic | 5501002903 | MI |
NPI | 1396927950 |
---|---|
Provider Name | Laura Kathleen Benavides |
First Address | Rochester Hills, MI 48307-4103 |
Second Address | Rochester Hills, MI 48307-4103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2007 |
Last Update Date | 12/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P55360003 | PTAN (01) | MI |