Provider Demographics
NPI:1700216371
Name:BENIGNO, SAMUEL DALOGDOG (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DALOGDOG
Last Name:BENIGNO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ORCHARD DRIVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICTON
Mailing Address - State:NEW BRUNSWICK
Mailing Address - Zip Code:E3C1K8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1329
Practice Address - Country:US
Practice Address - Phone:207-454-2544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist