Provider Demographics
NPI:1114982543
Name:BENEDICT, MARY K (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:BENEDICT
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 1:2374 VILLAGE COMMON DR
Mailing Address - Street 2:STE 100
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-7201
Mailing Address - Country:US
Mailing Address - Phone:814-454-2401
Mailing Address - Fax:814-459-5992
Practice Address - Street 1:2374 VILLAGE COMMON DR
Practice Address - Street 2:STE 100
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-7201
Practice Address - Country:US
Practice Address - Phone:814-835-0300
Practice Address - Fax:814-835-0305
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006521L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760618OtherHIGHMARK
PA096664YGBOtherMEDICARE - PA
1760618OtherHIGHMARK