Provider Demographics
NPI:1619244415
Name:BENEDICT, KIMBERLY ANN (ATC/L)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:BENEDICT
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1303
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-1303
Mailing Address - Country:US
Mailing Address - Phone:970-668-3633
Mailing Address - Fax:
Practice Address - Street 1:360 PEAK ONE DR.
Practice Address - Street 2:STE. 180
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-1303
Practice Address - Country:US
Practice Address - Phone:970-668-3633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer