Provider Demographics
NPI:1235291980
Name:BENSON, ROBERT J II (PT, OCS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:BENSON
Suffix:II
Gender:M
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MILL CREEK XING
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8701
Mailing Address - Country:US
Mailing Address - Phone:304-389-9283
Mailing Address - Fax:
Practice Address - Street 1:4605 MACCORKLE AVENUE SW
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309
Practice Address - Country:US
Practice Address - Phone:304-766-3589
Practice Address - Fax:304-766-3793
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV002427225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7808579OtherAETNA
WV31150445300OtherWORKERS COMP
WV3810000-760Medicaid
WV1714911OtherBLUE CROSS BLUE SHIELD
WV31150445300OtherWORKERS COMP
WV3810000-760Medicaid
WV7808579OtherAETNA