Provider Demographics
NPI:1396997631
Name:BENEDETTI, ERIN JEAN (PTA)
Entity type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:JEAN
Last Name:BENEDETTI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 OLD OAKS DR
Mailing Address - Street 2:3A
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1471
Mailing Address - Country:US
Mailing Address - Phone:815-793-1708
Mailing Address - Fax:
Practice Address - Street 1:2445 DEAN ST
Practice Address - Street 2:UNIT B
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-4828
Practice Address - Country:US
Practice Address - Phone:630-513-2700
Practice Address - Fax:630-513-2703
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.004757225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant