MEDICARE: KRISTI MARIE BENEDICT DPT

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	35249	CA

General Provider Information

NPI Number	:	1588802441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI MARIE BENEDICT DPT

Provider Business Mailing Address
First Line	:	3919 E PALM AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92869-2816
Country	:	US
Telephone Number	:	714-633-5062
Fax Number	:

Provider Business Practice Location Address
First Line	:	3919 E PALM AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92869-2816
Country	:	US
Telephone Number	:	714-633-5062
Fax Number	:

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

Provider Enumeration Date	:	01/30/2009
Last Update Date	:	01/30/2009

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