Provider Demographics
NPI:1346218328
Name:JOSEPH, BENOY (PT)
Entity type:Individual
Prefix:MR
First Name:BENOY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5690 CORYDALIS DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1685
Mailing Address - Country:US
Mailing Address - Phone:989-249-4164
Mailing Address - Fax:
Practice Address - Street 1:5690 CORYDALIS DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-1685
Practice Address - Country:US
Practice Address - Phone:989-249-4164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist