Provider Demographics
NPI:1245772094
Name:BENUCK, HILLARY JACKSON (DPT)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:JACKSON
Last Name:BENUCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:DANIELLE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:73 NEWTON RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-2440
Mailing Address - Country:US
Mailing Address - Phone:978-388-7272
Mailing Address - Fax:978-388-7373
Practice Address - Street 1:114 BATH RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2606
Practice Address - Country:US
Practice Address - Phone:207-884-8923
Practice Address - Fax:207-884-8972
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0014306225100000X
MEPT5026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist