Provider Demographics
NPI:1699831628
Name:BENSON, DEBORAH (PT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:BENSON
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 1:1917 ABBOTT RD
Mailing Address - Street 2:STE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3448
Mailing Address - Country:US
Mailing Address - Phone:907-279-4266
Mailing Address - Fax:907-279-4272
Practice Address - Street 1:506 GAFFNEY RD
Practice Address - Street 2:STE 300
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4914
Practice Address - Country:US
Practice Address - Phone:907-374-0992
Practice Address - Fax:907-372-0986
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT09841Medicaid
AK160448Medicare ID - Type UnspecifiedMEDICARE #