Provider Demographics
NPI:1477565000
Name:BENBOW, CARMEL S (PT)
Entity Type:Individual
Prefix:
First Name:CARMEL
Middle Name:S
Last Name:BENBOW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:855-771-0335
Mailing Address - Fax:
Practice Address - Street 1:475 PIONEER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-4905
Practice Address - Country:US
Practice Address - Phone:530-406-5620
Practice Address - Fax:530-406-5622
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0206870Medicaid
Q59670Medicare UPIN
0PT206870Medicare ID - Type Unspecified
CA0PT206871Medicare PIN