Provider Demographics
NPI:1326193855
Name:BENAVENTE-SCHUTZ, DANICA DIAZ (MPT)
Entity Type:Individual
Prefix:
First Name:DANICA
Middle Name:DIAZ
Last Name:BENAVENTE-SCHUTZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24421 MADISON ST STE 303
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6628
Mailing Address - Country:US
Mailing Address - Phone:310-429-6103
Mailing Address - Fax:
Practice Address - Street 1:24421 MADISON ST STE 303
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6628
Practice Address - Country:US
Practice Address - Phone:310-429-6103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28283225100000X
CAPT 28283225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist