Provider Demographics
NPI:1225073372
Name:BENGCO, LEAH MARIE NAGUIT (PT)
Entity Type:Individual
Prefix:MS
First Name:LEAH MARIE
Middle Name:NAGUIT
Last Name:BENGCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:MARIE
Other - Last Name:BENGCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:901 E MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2499
Mailing Address - Country:US
Mailing Address - Phone:423-586-6866
Mailing Address - Fax:423-581-9679
Practice Address - Street 1:901 E MORRIS BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2499
Practice Address - Country:US
Practice Address - Phone:423-586-6866
Practice Address - Fax:423-581-9679
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4117977OtherBCBS /BC PROVIDER
TN621773663OtherGROUP TAX ID
TN7404443OtherAETNA GROUP PROV. #
TN1364074OtherCIGNA GROUP PROV.#
TN621773663OtherGROUP TAX ID