Provider Demographics
NPI:1316376882
Name:BENEDICT, ROBERT DALE (AS PTA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DALE
Last Name:BENEDICT
Suffix:
Gender:M
Credentials:AS PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 E EMORY RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37938-4617
Mailing Address - Country:US
Mailing Address - Phone:865-947-6622
Mailing Address - Fax:865-947-6624
Practice Address - Street 1:970 E EMORY RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37938-4617
Practice Address - Country:US
Practice Address - Phone:865-947-6622
Practice Address - Fax:865-947-6624
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5492225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant