Provider Demographics
NPI:1073004487
Name:BENOIT, LAURA L (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:L
Last Name:BENOIT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10627 SE 74TH TER
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-9309
Mailing Address - Country:US
Mailing Address - Phone:352-693-6319
Mailing Address - Fax:
Practice Address - Street 1:1550 KILLINGSWORTH WAY
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-2175
Practice Address - Country:US
Practice Address - Phone:352-674-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13852225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant