Healthcare Provider Details

I. General information

NPI: 1710910609
Provider Name (Legal Business Name): JOHN C BENECK PT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 N GRANT AVE SUITE 100
LOVELAND CO
80538-8433
US

IV. Provider business mailing address

2712 MAROON CT
FORT COLLINS CO
80525-6148
US

V. Phone/Fax

Practice location:
  • Phone: 970-663-7780
  • Fax: 970-663-7781
Mailing address:
  • Phone: 970-229-0431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3071
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: