Provider Demographics
NPI:1093227951
Name:BENSON, DEVON
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:BENSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FGCU CAMPUS HOUSING CY04
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33965-0001
Mailing Address - Country:US
Mailing Address - Phone:740-649-3648
Mailing Address - Fax:
Practice Address - Street 1:1000 FGCU CAMPUS HOUSING CY04
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33965-0001
Practice Address - Country:US
Practice Address - Phone:740-649-3648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer