Healthcare Provider Details

I. General information

NPI: 1568496461
Provider Name (Legal Business Name): JESSICA BENES PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PIEDMONT ORTHOPAEDIC ASSOCIATES 35 INTERNATIONAL DRIVE
GREENVILLE SC
29615-4816
US

IV. Provider business mailing address

PO BOX 743294
ATLANTA GA
30374-3294
US

V. Phone/Fax

Practice location:
  • Phone: 864-234-7654
  • Fax: 864-675-1657
Mailing address:
  • Phone: 864-201-4301
  • Fax: 678-840-2112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4828
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: