Provider Demographics
NPI:1194841551
Name:BENKO, TERRY JO ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:JO ANN
Last Name:BENKO
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 1:1078 LOS OSOS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3237
Mailing Address - Country:US
Mailing Address - Phone:805-528-1190
Mailing Address - Fax:805-528-1378
Practice Address - Street 1:1078 LOS OSOS VALLEY RD
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3237
Practice Address - Country:US
Practice Address - Phone:805-528-1190
Practice Address - Fax:805-528-1378
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist