Provider Demographics
NPI:1891544177
Name:BENEFIELD, ZACHARY EDWARD (PT, DPT)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:EDWARD
Last Name:BENEFIELD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W HICKORY GROVE CT
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:IL
Mailing Address - Zip Code:61525-9454
Mailing Address - Country:US
Mailing Address - Phone:309-397-1379
Mailing Address - Fax:
Practice Address - Street 1:2359 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3902
Practice Address - Country:US
Practice Address - Phone:309-353-4767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.027815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist