Provider Demographics
NPI:1053373126
Name:BENTSON BECANIC, RHONDA ELLEN (PT)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:ELLEN
Last Name:BENTSON BECANIC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10320 E GAMMA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-8773
Mailing Address - Country:US
Mailing Address - Phone:412-498-2467
Mailing Address - Fax:
Practice Address - Street 1:6553 E BAYWOOD AVE STE 209
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1754
Practice Address - Country:US
Practice Address - Phone:480-712-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31183225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8398760Medicaid
WA0187451OtherDEPT. OF LABOR & INDUSTRY
WA911745305-98275-A008OtherTRICARE
WA911745305-98208-B025OtherTRICARE
WA1001290Medicaid
WA2252BEOtherREGENCE BLUE SHIELD
WA1515BEOtherREGENCE
WA8939182OtherL&I CRIME VICTIMS
WA911745305-98203-C002OtherTRICARE
WA5029BEOtherREGENCE BLUE SHIELD
WA7952583OtherAETNA
WA3452BEOtherREGENCE BLUE SHIELD
WAG8909724Medicare PIN
WA2252BEOtherREGENCE BLUE SHIELD