Healthcare Provider Details

I. General information

NPI: 1124691746
Provider Name (Legal Business Name): RHONDA KAYE BENAVIDES DN, MBA, PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 CARLISLE BLVD NE STE A
ALBUQUERQUE NM
87107-4529
US

IV. Provider business mailing address

4015 CARLISLE BLVD NE STE A
ALBUQUERQUE NM
87107-4529
US

V. Phone/Fax

Practice location:
  • Phone: 505-591-6277
  • Fax: 505-508-0932
Mailing address:
  • Phone: 505-591-6277
  • Fax: 505-509-0932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-0963
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License NumberDN2023-0002
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: