Individual
JEREMY BENACKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
16720 73RD PL N, MAPLE GROVE, MN 55311-2130
(612) 685-2919
Mailing address
16720 73RD PL N, MAPLE GROVE, MN 55311-2130
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5489
MN
Other
Enumeration date
08/02/2018
Last updated
08/02/2018
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