MEDICARE: MICHELE FRANCES BENEDISUK PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT 00009328	WA

General Provider Information

NPI Number	:	1063500627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE FRANCES BENEDISUK PT

Provider Business Mailing Address
First Line	:	PO BOX 11009
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98508-1009
Country	:	US
Telephone Number	:	360-352-2037
Fax Number	:	360-352-0637

Provider Business Practice Location Address
First Line	:	3603 S MCCLELLAN ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-5615
Country	:	US
Telephone Number	:	206-328-6517
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	03/25/2010

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