Provider Demographics
NPI:1215577879
Name:BENEDICT, GRAYSON
Entity Type:Individual
Prefix:
First Name:GRAYSON
Middle Name:
Last Name:BENEDICT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50233-7706
Mailing Address - Country:US
Mailing Address - Phone:515-494-8462
Mailing Address - Fax:
Practice Address - Street 1:1113 GRANT ST
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:IA
Practice Address - Zip Code:50233-7706
Practice Address - Country:US
Practice Address - Phone:515-494-8462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer