Provider Demographics
NPI:1578943759
Name:BENITEZ, YOLANDA (DPT)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:BENITEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:
Other - Last Name:ESPARZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4210 E BASELINE RD
Mailing Address - Street 2:STE 106
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4417
Mailing Address - Country:US
Mailing Address - Phone:480-503-2373
Mailing Address - Fax:480-782-5213
Practice Address - Street 1:4210 E BASELINE RD
Practice Address - Street 2:STE 106
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4417
Practice Address - Country:US
Practice Address - Phone:480-503-2373
Practice Address - Fax:480-782-5213
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11573225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist