Individual
C RIC BENEDETTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1033 W QUINN RD, 560 MEMORIAL DR, POCATELLO, ID 83202-2425
(208) 233-4800
(208) 233-4887
Mailing address
PO BOX 2844, POCATELLO, ID 83206-2844
(208) 233-4800
(208) 233-4887
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT131
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010008588
BLUE SHIELD
ID
05
—
004396600
—
ID
01
—
650009795
RAILROAD MEDICARE
ID
01
—
T1542
BLUE CROSS
ID
Enumeration date
10/12/2006
Last updated
02/04/2010
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