Provider Demographics
NPI:1831303544
Name:BENECK, GEORGE JAMES (PT, MS, OCS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:JAMES
Last Name:BENECK
Suffix:
Gender:M
Credentials:PT, MS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10846 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2375
Mailing Address - Country:US
Mailing Address - Phone:562-985-1974
Mailing Address - Fax:562-985-4069
Practice Address - Street 1:3500 LOMITA BLVD STE M100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5037
Practice Address - Country:US
Practice Address - Phone:310-325-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist