Provider Demographics
NPI:1235780768
Name:BENICKA, JANA (MS, LMT, CMMP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:BENICKA
Suffix:
Gender:F
Credentials:MS, LMT, CMMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GREAT PINES CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3147
Mailing Address - Country:US
Mailing Address - Phone:240-264-0986
Mailing Address - Fax:
Practice Address - Street 1:15717 CRABBS BRANCH WAY # 227
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-6650
Practice Address - Country:US
Practice Address - Phone:205-336-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMO5655225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist