Provider Demographics
NPI:1124417191
Name:BENSEN, MEGHAN JOY (DPT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:JOY
Last Name:BENSEN
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 1:4615 SCOTTS VALLEY DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-4278
Mailing Address - Country:US
Mailing Address - Phone:831-438-4478
Mailing Address - Fax:831-438-5059
Practice Address - Street 1:4615 SCOTTS VALLEY DR
Practice Address - Street 2:SUITE D
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4278
Practice Address - Country:US
Practice Address - Phone:831-438-4478
Practice Address - Fax:831-438-5059
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist