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General NPI Number Information
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NPI Number | 1235780768
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Entity Type | Individual
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Provider Name | JANA BENICKA MS, LMT, CMMP
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Gender | Female
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 15717 CRABBS BRANCH WAY # 227
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City | ROCKVILLE
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State | MD
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Zip | 20855-6650
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Country | US
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Telephone | 205-336-1115
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Fax |
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Provider Business Mailing Address
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Address Line | 6 GREAT PINES CT
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City | ROCKVILLE
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State | MD
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Zip | 20850-3147
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Country | US
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Telephone | 240-264-0986
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MO5655
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License Number State | MD
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