Provider Demographics
NPI:1992475149
Name:BENETZ, DEANNE CAROLE (MPT)
Entity type:Individual
Prefix:MRS
First Name:DEANNE
Middle Name:CAROLE
Last Name:BENETZ
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 1:1026 DEEP WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-6309
Mailing Address - Country:US
Mailing Address - Phone:408-506-1741
Mailing Address - Fax:
Practice Address - Street 1:1026 DEEP WOODS TRL
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-6309
Practice Address - Country:US
Practice Address - Phone:408-506-1741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13867261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy