Provider Demographics
NPI:1083993489
Name:BENEDICT, MARK ARDEN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ARDEN
Last Name:BENEDICT
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 ARBOR VISTA LOOP
Mailing Address - Street 2:# 225
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1683
Mailing Address - Country:US
Mailing Address - Phone:386-747-0790
Mailing Address - Fax:
Practice Address - Street 1:1341 ARBOR VISTA LOOP
Practice Address - Street 2:# 225
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1683
Practice Address - Country:US
Practice Address - Phone:386-747-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 11102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer