Provider Demographics
NPI:1235104142
Name:BENINATO, PHILIP (PT)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:BENINATO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 N NEWTOWN STREET RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2319
Practice Address - Country:US
Practice Address - Phone:484-420-2680
Practice Address - Fax:610-325-2108
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005481L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP01334426OtherRAILROAD MEDICARE
PA239697VKFMedicare PIN
PAP01334426OtherRAILROAD MEDICARE