MEDICARE: JANICE E DIBENEDETTO 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
1	225100000X	Physical Therapist	PT13701	CA

General Provider Information

NPI Number	:	1942372495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE E DIBENEDETTO P.T.

Provider Business Mailing Address
First Line	:	3195 WARBURTON AVE
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-2745
Country	:	US
Telephone Number	:	408-984-2083
Fax Number	:	408-241-1857

Provider Business Practice Location Address
First Line	:	3195 WARBURTON AVE
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-2745
Country	:	US
Telephone Number	:	408-984-2083
Fax Number	:	408-241-1857

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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