Provider Demographics
NPI:1821794371
Name:BENTON, JOSHUA (DPT)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:BENTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 THOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2630
Mailing Address - Country:US
Mailing Address - Phone:214-681-6713
Mailing Address - Fax:
Practice Address - Street 1:750 W BONDS RANCH RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76131-3900
Practice Address - Country:US
Practice Address - Phone:682-428-7532
Practice Address - Fax:682-428-7534
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1372318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist