Provider Demographics
NPI:1225267313
Name:BENEDICT, TIMOTHY MARK (DPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MARK
Last Name:BENEDICT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 GLENNAN ROAD
Mailing Address - Street 2:SCHOFIELD PHYSICAL THERAPY CLINIC
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-3651
Mailing Address - Country:US
Mailing Address - Phone:808-433-8751
Mailing Address - Fax:
Practice Address - Street 1:686 GLENNAN ROAD
Practice Address - Street 2:SCHOFIELD PHYSICAL THERAPY CLINIC
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-3651
Practice Address - Country:US
Practice Address - Phone:808-433-8751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10420225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN