Provider Demographics
NPI:1720400062
Name:BENGTSON, ERIC (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BENGTSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 PEARL ST UNIT 209
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-2278
Mailing Address - Country:US
Mailing Address - Phone:508-223-2300
Mailing Address - Fax:
Practice Address - Street 1:80 PARK ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2335
Practice Address - Country:US
Practice Address - Phone:508-223-2300
Practice Address - Fax:508-223-2340
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251S0007X
NC14982255A2300X
MA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer