Provider Demographics
NPI:1629635966
Name:BENARDO, OLGA BOROVIC
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:BOROVIC
Last Name:BENARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 N 35TH ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49053-9761
Mailing Address - Country:US
Mailing Address - Phone:408-889-3829
Mailing Address - Fax:
Practice Address - Street 1:14 EDEN VALLEY CT
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:CA
Practice Address - Zip Code:95713-9125
Practice Address - Country:US
Practice Address - Phone:408-889-3829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003605225100000X
NV63312251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics