Provider Demographics
NPI:1659495299
Name:BENES, ALISCIA MICHELLE (ATC)
Entity Type:Individual
Prefix:MRS
First Name:ALISCIA
Middle Name:MICHELLE
Last Name:BENES
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2276 STATE HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NE
Mailing Address - Zip Code:68620-5034
Mailing Address - Country:US
Mailing Address - Phone:402-395-6227
Mailing Address - Fax:
Practice Address - Street 1:605 S 6TH ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NE
Practice Address - Zip Code:68620-1543
Practice Address - Country:US
Practice Address - Phone:402-395-2134
Practice Address - Fax:402-395-2137
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer