Provider Demographics
NPI:1386651040
Name:BENSON, DAVID JOSEPH (DPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
Last Name:BENSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7004
Mailing Address - Country:US
Mailing Address - Phone:817-498-8585
Mailing Address - Fax:817-498-8582
Practice Address - Street 1:5060 DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7004
Practice Address - Country:US
Practice Address - Phone:817-498-8585
Practice Address - Fax:817-498-8582
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2329225100000X
TX1199151225100000X
UT3592542401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1650056OtherMEDICARE PTAN
IDTD702OtherBLUE CROSS OF IDAHO
UT000064597OtherMEDICARE PTAN
UT35925424000001OtherREGENCE BLUECROSS BLUESHIELD OF UTAH