Provider Demographics
NPI:1750810222
Name:BENANDI, CHARLES MCLAIN (DPT)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:MCLAIN
Last Name:BENANDI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W BELLEVUE DR STE 5
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2591
Mailing Address - Country:US
Mailing Address - Phone:818-925-8094
Mailing Address - Fax:
Practice Address - Street 1:117 W BELLEVUE DR STE 5
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2591
Practice Address - Country:US
Practice Address - Phone:818-925-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist