Healthcare Provider Details

I. General information

NPI: 1285454405
Provider Name (Legal Business Name): MEGAN ELIZABETH BENEDICT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8620 TURNSTONE SHORE LN
RIVERVIEW FL
33578-8660
US

IV. Provider business mailing address

8620 TURNSTONE SHORE LN
RIVERVIEW FL
33578-8660
US

V. Phone/Fax

Practice location:
  • Phone: 949-701-2459
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number27777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: