Provider Demographics
NPI:1023542479
Name:BENTHUSEN, DEREK DAVID (PT,DPT,ATC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:DAVID
Last Name:BENTHUSEN
Suffix:
Gender:M
Credentials:PT,DPT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3890 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-7186
Mailing Address - Country:US
Mailing Address - Phone:352-674-4700
Mailing Address - Fax:
Practice Address - Street 1:3890 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-7186
Practice Address - Country:US
Practice Address - Phone:352-674-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31173225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist