Provider Demographics
NPI:1710910609
Name:BENECK, JOHN C (PT, OCS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:BENECK
Suffix:
Gender:M
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 MAROON CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-6148
Mailing Address - Country:US
Mailing Address - Phone:970-229-0431
Mailing Address - Fax:
Practice Address - Street 1:3880 N GRANT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8433
Practice Address - Country:US
Practice Address - Phone:970-663-7780
Practice Address - Fax:970-663-7781
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30712251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32776845Medicaid
CO501598Medicare ID - Type Unspecified