Provider Demographics
NPI:1881652113
Name:BENEVIDES, ZACHARY PAUL (MPT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:PAUL
Last Name:BENEVIDES
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 CHERRY WOOD CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4851
Mailing Address - Country:US
Mailing Address - Phone:215-767-7103
Mailing Address - Fax:
Practice Address - Street 1:2 DEVON SQ
Practice Address - Street 2:744 W. LANCASTER AVENUE
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-2523
Practice Address - Country:US
Practice Address - Phone:610-688-7776
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist