Provider Demographics
NPI:1417518325
Name:BENAVIDES, CODY ANDREW (DPT)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:ANDREW
Last Name:BENAVIDES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11216 MADERA CIR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1497
Mailing Address - Country:US
Mailing Address - Phone:216-789-4801
Mailing Address - Fax:
Practice Address - Street 1:1901 S 72ND ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1200
Practice Address - Country:US
Practice Address - Phone:253-475-4870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-23
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist