Provider Demographics
NPI:1346602828
Name:BENDA, CAROLE (LMT)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:
Last Name:BENDA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 QUINCY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8230
Mailing Address - Country:US
Mailing Address - Phone:605-348-2116
Mailing Address - Fax:
Practice Address - Street 1:623 QUINCY ST STE 101
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8230
Practice Address - Country:US
Practice Address - Phone:605-348-2116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDMT11437225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist