Provider Demographics
NPI:1033359781
Name:BENEDICT, PATRICIA LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 KELSON
Mailing Address - Street 2:SUITEC
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446
Mailing Address - Country:US
Mailing Address - Phone:850-482-2264
Mailing Address - Fax:850-482-5270
Practice Address - Street 1:4215 KELSON AVE
Practice Address - Street 2:SUITEC
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-8211
Practice Address - Country:US
Practice Address - Phone:850-482-2264
Practice Address - Fax:850-482-5270
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA22900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist