Provider Demographics
NPI:1326209396
Name:BENSON, EILEEN MALLOY (MS, PT)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:MALLOY
Last Name:BENSON
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 S 16TH ST
Mailing Address - Street 2:5108
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4526
Mailing Address - Country:US
Mailing Address - Phone:414-647-7422
Mailing Address - Fax:414-647-6983
Practice Address - Street 1:3237 S 16TH ST
Practice Address - Street 2:5108
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4526
Practice Address - Country:US
Practice Address - Phone:414-647-7422
Practice Address - Fax:414-647-6983
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist