Provider Demographics
NPI:1558335653
Name:BENSINK, FLORA A (PT)
Entity Type:Individual
Prefix:
First Name:FLORA
Middle Name:A
Last Name:BENSINK
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 1:1524 ENTERPRISE RD
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-8576
Mailing Address - Country:US
Mailing Address - Phone:814-664-9346
Mailing Address - Fax:814-663-0169
Practice Address - Street 1:1524 ENTERPRISE RD
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-8576
Practice Address - Country:US
Practice Address - Phone:814-664-9346
Practice Address - Fax:814-663-0169
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001999L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA457211OtherHIGHMARK