Provider Demographics
NPI:1023206422
Name:TOBIAS, BENITA REOLAINE (PT, CLT)
Entity Type:Individual
Prefix:MS
First Name:BENITA
Middle Name:REOLAINE
Last Name:TOBIAS
Suffix:
Gender:F
Credentials:PT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 PALMETTO PARK BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7968
Mailing Address - Country:US
Mailing Address - Phone:803-359-2323
Mailing Address - Fax:803-359-2331
Practice Address - Street 1:108 PALMETTO PARK BLVD
Practice Address - Street 2:STE B
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7968
Practice Address - Country:US
Practice Address - Phone:803-359-2323
Practice Address - Fax:803-359-2331
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist