MEDICARE: MISS ERIN JEAN BENEDETTI PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	160.004757	IL

General Provider Information

NPI Number	:	1396997631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ERIN JEAN BENEDETTI PTA

Provider Business Mailing Address
First Line	:	4715 OLD OAKS DR
Second Line	:	3A
City	:	LISLE
State	:	IL
Zip	:	60532-1471
Country	:	US
Telephone Number	:	815-793-1708
Fax Number	:

Provider Business Practice Location Address
First Line	:	2445 DEAN ST
Second Line	:	UNIT B
City	:	ST CHARLES
State	:	IL
Zip	:	60175-4828
Country	:	US
Telephone Number	:	630-513-2700
Fax Number	:	630-513-2703

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2008
Last Update Date	:	10/17/2008

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