Provider Demographics
NPI:1083834196
Name:BENJAMIN, THERESA (DPT)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 MIDPOINT DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-224-4141
Mailing Address - Fax:970-797-1227
Practice Address - Street 1:2108 MIDPOINT DRIVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-224-4141
Practice Address - Fax:970-797-1227
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7779225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist