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1174001010
JEREMY BENACKA
MAPLE GROVE, MN
NPI
1174001010
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225100000X Physical Therapist
(Licence: MN 5489)
Enumeration Date
2018-08-02
Last Update Date
2018-08-02
Business Address
JEREMY BENACKA
16720 73RD PL N
MAPLE GROVE, MN 55311-2130
Phone number: 612-685-2919
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Mailing Address
JEREMY BENACKA
16720 73RD PL N
MAPLE GROVE, MN 55311-2130
Phone number:
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