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General NPI Number Information
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NPI Number | 1194859322
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Entity Type | Individual
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Provider Name | BRENDA C BENEFIEL PTA
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Gender | Female
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11167 HWY 67
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City | BENTON
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State | AR
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Zip | 72015
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Country | US
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Telephone | 501-860-0808
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Fax | 501-860-0807
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Provider Business Mailing Address
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Address Line | 24 PINTO TRL
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City | GREENBRIER
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State | AR
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Zip | 72058-9772
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Country | US
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Telephone | 501-860-0808
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Fax | 501-860-0807
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PTA1368
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License Number State | AR
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