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Individual

LOT DI BENEDETTO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
1607 7TH ST, STE C, LAS VEGAS, NM 87701-4952
(505) 454-1213
Mailing address
1607 7TH ST, STE C, LAS VEGAS, NM 87701-4952
(469) 693-2568

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1220967
TX
225100000X
Physical Therapist
Primary
36565
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
46956204
NM
Enumeration date
06/20/2011
Last updated
10/21/2019
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