Provider Demographics
NPI:1235252784
Name:BENSON, TRICIA SUE (DPT)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:SUE
Last Name:BENSON
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 1:929 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4447
Mailing Address - Country:US
Mailing Address - Phone:831-373-1209
Mailing Address - Fax:831-373-7102
Practice Address - Street 1:929 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4447
Practice Address - Country:US
Practice Address - Phone:831-373-1209
Practice Address - Fax:831-373-7102
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 30225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 30225OtherLICENSE