Provider Demographics
NPI:1194951160
Name:BENISH, GLORIA JEAN (MSPT)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:JEAN
Last Name:BENISH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14505 MAIL ROUTE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-6175
Mailing Address - Country:US
Mailing Address - Phone:501-888-3463
Mailing Address - Fax:
Practice Address - Street 1:8625 W MARKHAM ST
Practice Address - Street 2:C
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2312
Practice Address - Country:US
Practice Address - Phone:501-219-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist