Provider Demographics
NPI:1114678232
Name:BENTON, JOSTON (PT, DPT, MS)
Entity Type:Individual
Prefix:
First Name:JOSTON
Middle Name:
Last Name:BENTON
Suffix:
Gender:M
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 H ST NE STE 2512
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3627
Mailing Address - Country:US
Mailing Address - Phone:301-531-4741
Mailing Address - Fax:
Practice Address - Street 1:1101 15TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-5002
Practice Address - Country:US
Practice Address - Phone:301-531-4741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2023-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28823225100000X
DCPT210002176225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist