Provider Demographics
NPI:1861814519
Name:BENSON, ROBERTA ANNE (CMT, LMT, BA)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:ANNE
Last Name:BENSON
Suffix:
Gender:F
Credentials:CMT, LMT, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 ULYSSES ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-3048
Mailing Address - Country:US
Mailing Address - Phone:612-203-2872
Mailing Address - Fax:
Practice Address - Street 1:2233 HAMLINE AVE N STE 433
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-5006
Practice Address - Country:US
Practice Address - Phone:651-600-6181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist