Provider Demographics
NPI:1053384123
Name:BENEK-EDWARDS, MARIANNE (PT)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:BENEK-EDWARDS
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 1:95 BULLDOG BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3332
Mailing Address - Country:US
Mailing Address - Phone:321-722-9305
Mailing Address - Fax:321-674-1600
Practice Address - Street 1:95 BULLDOG BLVD
Practice Address - Street 2:STE 200
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3332
Practice Address - Country:US
Practice Address - Phone:321-722-9305
Practice Address - Fax:321-674-1600
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0663ZMedicare ID - Type Unspecified
FLP89353Medicare UPIN