Provider Demographics
NPI:1255330734
Name:HOWARD, BENSON W (PT)
Entity Type:Individual
Prefix:
First Name:BENSON
Middle Name:W
Last Name:HOWARD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10130 SUPERIOR WAY
Mailing Address - Street 2:
Mailing Address - City:AMELIA COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23002-4744
Mailing Address - Country:US
Mailing Address - Phone:804-561-1585
Mailing Address - Fax:804-561-7430
Practice Address - Street 1:10130 SUPERIOR WAY
Practice Address - Street 2:
Practice Address - City:AMELIA COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23002-4744
Practice Address - Country:US
Practice Address - Phone:804-561-1585
Practice Address - Fax:804-561-7430
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-12-06
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
VA2305006161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA460948OtherBCBS PROVIDER
VA39769OtherCARE NET
VA199960OtherSOUTHERN HEALTH PROVIDER
VA7954419OtherAETNA PROVIDER
VADB7288OtherRAIL ROAD MEDICARE
VA235571OtherMAMSI PROVIDER
VA199960OtherSOUTHERN HEALTH PROVIDER