Provider Demographics
NPI:1629058672
Name:BENJAMIN, ANNE (PT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:BENJAMIN
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 1:3167 LINDEN RD
Mailing Address - Street 2:207
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-4170
Mailing Address - Country:US
Mailing Address - Phone:440-333-2354
Mailing Address - Fax:
Practice Address - Street 1:18660 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3480
Practice Address - Country:US
Practice Address - Phone:440-238-8300
Practice Address - Fax:440-234-8474
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-00028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBE0877101Medicare ID - Type Unspecified