Provider Demographics
NPI:1679640163
Name:BENGE, KIMBERLYN ANN (PT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLYN
Middle Name:ANN
Last Name:BENGE
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9160 E SHEA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6266
Practice Address - Country:US
Practice Address - Phone:480-222-0655
Practice Address - Fax:480-222-1457
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070004905OtherLICENSE
ILK12775Medicare PIN