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Individual
JODI BENHAM
Active
Individual
JODI BENHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1218376TX
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
307335501
—
TX
05
—
370335502
—
TX
01
—
540040100
FIRSTCARE
TX
01
—
877T26
BLUE CROSS BLUE SHIELD
TX
01
—
P01108473
MEDICARE RAILROAD
TX
Enumeration date
07/18/2012
Last updated
01/07/2013
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