Provider Demographics
NPI:1588802441
Name:BENEDICT, KRISTI MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:MARIE
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 E PALM AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-2816
Mailing Address - Country:US
Mailing Address - Phone:714-633-5062
Mailing Address - Fax:
Practice Address - Street 1:3919 E PALM AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-2816
Practice Address - Country:US
Practice Address - Phone:714-633-5062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35249225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist