Provider Demographics
NPI:1568169514
Name:BENITEZ, EDWARD ALONSO (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALONSO
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SPEER BLVD APT 619
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2670
Mailing Address - Country:US
Mailing Address - Phone:469-274-0232
Mailing Address - Fax:
Practice Address - Street 1:333 DAD CLARK DR
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-2444
Practice Address - Country:US
Practice Address - Phone:720-480-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018926225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist