Healthcare Provider Details

I. General information

NPI: 1528526878
Provider Name (Legal Business Name): BENO M CHERIAN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 PRIOR RD APT D
WILMINGTON DE
19809-1152
US

IV. Provider business mailing address

2217 PRIOR RD APT D
WILMINGTON DE
19809-1152
US

V. Phone/Fax

Practice location:
  • Phone: 469-826-0615
  • Fax: 855-232-8604
Mailing address:
  • Phone: 469-826-0615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0000981
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: