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NPI Code Detail

MEDICARE: MS. JENNA NICOLE BENJAMIN MPT

MEDICARE:  MS. JENNA NICOLE BENJAMIN  MPT
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
1225100000XPhysical Therapist10234NC

General Provider Information

NPI Number : 1184911992
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNA NICOLE BENJAMIN MPT
Provider Business Mailing Address
First Line : 3001 SPRING FOREST RD
Second Line :
City : RALEIGH
State : NC
Zip : 27616-2815
Country : US
Telephone Number : 919-424-5080
Fax Number :
Provider Business Practice Location Address
First Line : 10810 SANDY OAK LN
Second Line :
City : RALEIGH
State : NC
Zip : 27614-8386
Country : US
Telephone Number : 919-846-7147
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2011
Last Update Date : 06/30/2011

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Directions to “ MS. JENNA NICOLE BENJAMIN MPT” Practice Location

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