Provider Demographics
NPI:1417052440
Name:BENSCH, ALLYSON GRAVES (PT)
Entity Type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:GRAVES
Last Name:BENSCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8084 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-8667
Mailing Address - Country:US
Mailing Address - Phone:843-717-2400
Mailing Address - Fax:
Practice Address - Street 1:8084 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8667
Practice Address - Country:US
Practice Address - Phone:843-717-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC426633Medicare ID - Type UnspecifiedOUT-PT PHYSICAL THERAPY