Provider Demographics
NPI:1104424118
Name:BENEVENTO, TAYLOR (MSPT)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:
Last Name:BENEVENTO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 WEED ST
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-6118
Mailing Address - Country:US
Mailing Address - Phone:917-579-4423
Mailing Address - Fax:
Practice Address - Street 1:77 3RD ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-4722
Practice Address - Country:US
Practice Address - Phone:203-204-3092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12605225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist