Provider Demographics
NPI:1316100332
Name:BENTO, JESSICA MARIE
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MARIE
Last Name:BENTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10098 E EVANS DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7573
Mailing Address - Country:US
Mailing Address - Phone:248-212-5277
Mailing Address - Fax:
Practice Address - Street 1:9393 N 90TH ST
Practice Address - Street 2:STE 118
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5040
Practice Address - Country:US
Practice Address - Phone:480-272-7641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ73972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic