Individual
TOM BENOLERAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
324 N 1680 E, PHYSICAL THERAPY DEPT, SAINT GEORGE, UT 84790-2500
(845) 464-6382
(845) 464-6382
Mailing address
2053 W 1820 N, SAINT GEORGE, UT 84770-4856
(845) 464-6382
(845) 464-6382
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10586212-2401
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02566383
—
NY
01
—
1000043901
AFFINITY
NY
01
—
173774P
HIP
NY
01
—
Q13E71
EMPIRE BLUE CROSS BLUE SHIELD
NY
Enumeration date
11/02/2006
Last updated
12/20/2023
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