Provider Demographics
NPI:1336543792
Name:BENZEL, MELODY
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:BENZEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 BLACKHAWK PLAZA CIR
Mailing Address - Street 2:#275
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4904
Mailing Address - Country:US
Mailing Address - Phone:925-736-1305
Mailing Address - Fax:
Practice Address - Street 1:4165 BLACKHAWK PLAZA CIR
Practice Address - Street 2:#275
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4904
Practice Address - Country:US
Practice Address - Phone:925-736-1305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413502251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic