Provider Demographics
NPI:1730317819
Name:BENSON, LEIGH TRACY (CMT, NCTMB)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:TRACY
Last Name:BENSON
Suffix:
Gender:F
Credentials:CMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 225TH LN NW
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:MN
Mailing Address - Zip Code:55005-9539
Mailing Address - Country:US
Mailing Address - Phone:612-308-4491
Mailing Address - Fax:
Practice Address - Street 1:854 225TH LN NW
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:MN
Practice Address - Zip Code:55005-9539
Practice Address - Country:US
Practice Address - Phone:612-308-4491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist