Provider Demographics
NPI:1790988459
Name:BENZ, TONY MATTHEW (MHSC, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:MATTHEW
Last Name:BENZ
Suffix:
Gender:M
Credentials:MHSC, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 GEARY ST NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-8210
Mailing Address - Country:US
Mailing Address - Phone:704-787-4618
Mailing Address - Fax:
Practice Address - Street 1:8220 UNIVERSITY EXECUTIVE PARK DRIVE
Practice Address - Street 2:SUITE 140
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262
Practice Address - Country:US
Practice Address - Phone:704-547-1129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer