Provider Demographics
NPI:1033683446
Name:BENKO, NATALIE (PTA)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:BENKO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 TUTT BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3574
Mailing Address - Country:US
Mailing Address - Phone:719-266-0438
Mailing Address - Fax:719-574-7388
Practice Address - Street 1:6140 TUTT BLVD STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3574
Practice Address - Country:US
Practice Address - Phone:719-266-0438
Practice Address - Fax:719-574-7388
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0014378225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant