Provider Demographics
NPI:1932227865
Name:BENCI, GLORIA M (MS,PT)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:M
Last Name:BENCI
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16955 OLD RIVER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-5118
Mailing Address - Country:US
Mailing Address - Phone:503-675-9760
Mailing Address - Fax:
Practice Address - Street 1:16955 OLD RIVER DR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-5118
Practice Address - Country:US
Practice Address - Phone:503-675-9760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3559OtherPT STATE LICENSURE