Provider Demographics
NPI:1629355854
Name:BENSON, REBECCA (ATC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 RIVERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5301
Mailing Address - Country:US
Mailing Address - Phone:952-820-5825
Mailing Address - Fax:
Practice Address - Street 1:1639 RIVERWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-7533
Practice Address - Country:US
Practice Address - Phone:952-820-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer