Provider Demographics
NPI:1285635482
Name:BENJAMIN, SCOTT (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:BENJAMIN
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 1:416 S CREYTS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8290
Mailing Address - Country:US
Mailing Address - Phone:517-327-0966
Mailing Address - Fax:517-327-0986
Practice Address - Street 1:416 S CREYTS RD
Practice Address - Street 2:SUITE B
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8290
Practice Address - Country:US
Practice Address - Phone:517-327-0966
Practice Address - Fax:517-327-0986
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISB003898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G80002OtherBCBS OF MICHIGAN
MIP26307FOtherBLUE CARE NETWORK MI
MI6400055OtherPHP