Provider Demographics
NPI:1093047516
Name:BENZ, PATRICIA AGNES (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:AGNES
Last Name:BENZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 MIDWOOD AVE.
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2027
Mailing Address - Country:US
Mailing Address - Phone:631-366-1446
Mailing Address - Fax:
Practice Address - Street 1:51 MIDWOOD AVE.
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2027
Practice Address - Country:US
Practice Address - Phone:631-366-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004834-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics