Provider Demographics
NPI:1447038609
Name:ARROYO ROSA, BENEDICT JOMAL (ATC)
Entity type:Individual
Prefix:
First Name:BENEDICT
Middle Name:JOMAL
Last Name:ARROYO ROSA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30971 W COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-6821
Mailing Address - Country:US
Mailing Address - Phone:602-420-3653
Mailing Address - Fax:
Practice Address - Street 1:3805 N 53RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-3046
Practice Address - Country:US
Practice Address - Phone:414-218-3939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3100-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer