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Individual
LAURA KATHLEEN BENAVIDES
Active
Individual
LAURA KATHLEEN BENAVIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501002903
MI
2251G0304X
Geriatric Physical Therapist
5501002903
MI
2251N0400X
Neurology Physical Therapist
5501002903
MI
2251P0200X
Pediatric Physical Therapist
5501002903
MI
2251X0800X
Orthopedic Physical Therapist
5501002903
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P55360003
PTAN
MI
Enumeration date
12/05/2007
Last updated
05/12/2008
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