Provider Demographics
NPI:1104240100
Name:BENOCK, JOHN RILEY (DPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:RILEY
Last Name:BENOCK
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 1:4031 N DIXIE HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7874
Mailing Address - Country:US
Mailing Address - Phone:270-982-4776
Mailing Address - Fax:
Practice Address - Street 1:4031 N DIXIE HWY STE 104
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7874
Practice Address - Country:US
Practice Address - Phone:270-982-4776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist