Provider Demographics
NPI:1598034308
Name:CAROL BENJAMIN, PT, LLC
Entity Type:Organization
Organization Name:CAROL BENJAMIN, PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-938-3770
Mailing Address - Street 1:2119 WESTLAKE DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-8102
Mailing Address - Country:US
Mailing Address - Phone:303-684-9456
Mailing Address - Fax:
Practice Address - Street 1:6640 GUNPARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-7000
Practice Address - Country:US
Practice Address - Phone:303-938-3770
Practice Address - Fax:720-542-8932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3878261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy