Provider Demographics
NPI:1225037633
Name:BENHAM, TERRY LYNN (PT)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LYNN
Last Name:BENHAM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16410 SMOKEY POINT BLVD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8415
Mailing Address - Country:US
Mailing Address - Phone:360-658-7334
Mailing Address - Fax:360-657-8453
Practice Address - Street 1:16410 SMOKEY POINT BLVD
Practice Address - Street 2:SUITE 309
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8415
Practice Address - Country:US
Practice Address - Phone:360-658-7334
Practice Address - Fax:360-657-8453
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00000609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4676387OtherAETNA
78965OtherSTATE LABOR & INDUSTRIES
WA78965OtherLABOR & INDUSTRY
WA6650019733OtherRR MEDICARE
WABE4480OtherBLUE SHIELD
78965OtherSTATE LABOR & INDUSTRIES