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NPI Code Detail

MEDICARE: LAURA KATHLEEN BENAVIDES P.T.

MEDICARE:   LAURA KATHLEEN BENAVIDES  P.T.
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 Therapist5501002903MI
22251G0304XGeriatric Physical Therapist5501002903MI
32251N0400XNeurology Physical Therapist5501002903MI
42251P0200XPediatric Physical Therapist5501002903MI
52251X0800XOrthopedic Physical Therapist5501002903MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P55360003OTHERMIPTAN

General Provider Information

NPI Number : 1396927950
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA KATHLEEN BENAVIDES P.T.
Provider Business Mailing Address
First Line : 141 HAMPTON CIR
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48307-4103
Country : US
Telephone Number : 248-853-7555
Fax Number : 248-853-7556
Provider Business Practice Location Address
First Line : 141 HAMPTON CIR
Second Line :
City : ROCHESTER HILLS
State : MI
Zip : 48307-4103
Country : US
Telephone Number : 248-853-7555
Fax Number : 248-853-7556
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2007
Last Update Date : 05/12/2008

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Directions to “ LAURA KATHLEEN BENAVIDES P.T.” Practice Location

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