Provider Demographics
NPI:1942372495
Name:DIBENEDETTO, JANICE E (PT)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:E
Last Name:DIBENEDETTO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 WARBURTON AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-2745
Mailing Address - Country:US
Mailing Address - Phone:408-984-2083
Mailing Address - Fax:408-241-1857
Practice Address - Street 1:3195 WARBURTON AVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-2745
Practice Address - Country:US
Practice Address - Phone:408-984-2083
Practice Address - Fax:408-241-1857
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist