Provider Demographics
NPI:1558784777
Name:BENGS, HEATHER DENISE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DENISE
Last Name:BENGS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2038
Mailing Address - Country:US
Mailing Address - Phone:918-622-4126
Mailing Address - Fax:
Practice Address - Street 1:176 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495-9700
Practice Address - Country:US
Practice Address - Phone:903-482-9741
Practice Address - Fax:903-482-9742
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist