Provider Demographics
NPI:1578852216
Name:DEBENEDETTO, ROBIN J (LMT,MMP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:J
Last Name:DEBENEDETTO
Suffix:
Gender:F
Credentials:LMT,MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4967 CARDAMON LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-5323
Mailing Address - Country:US
Mailing Address - Phone:815-540-2467
Mailing Address - Fax:
Practice Address - Street 1:4967 CARDAMON LN
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-5323
Practice Address - Country:US
Practice Address - Phone:815-540-2467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.007262225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist