Provider Demographics
NPI:1518904341
Name:BENHARDT, ELMER HENRY (LPT)
Entity Type:Individual
Prefix:
First Name:ELMER
Middle Name:HENRY
Last Name:BENHARDT
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 INTERSTATE 45 N
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-4901
Mailing Address - Country:US
Mailing Address - Phone:936-522-4731
Mailing Address - Fax:936-522-4737
Practice Address - Street 1:4015 INTERSTATE 45 N
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-4901
Practice Address - Country:US
Practice Address - Phone:936-522-4731
Practice Address - Fax:936-522-4737
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183822901Medicaid
TX183822901Medicaid