Provider Demographics
NPI:1306064886
Name:BENORE, JANEL (MPT)
Entity type:Individual
Prefix:MS
First Name:JANEL
Middle Name:
Last Name:BENORE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1464
Mailing Address - Country:US
Mailing Address - Phone:269-429-5447
Mailing Address - Fax:269-429-5447
Practice Address - Street 1:3408 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9601
Practice Address - Country:US
Practice Address - Phone:269-429-5447
Practice Address - Fax:269-429-5447
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010092202251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic