Provider Demographics
NPI:1922563857
Name:BENSON, ANGELA HEATHER
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:HEATHER
Last Name:BENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:JOPPA
Mailing Address - State:AL
Mailing Address - Zip Code:35087-6266
Mailing Address - Country:US
Mailing Address - Phone:256-586-6480
Mailing Address - Fax:
Practice Address - Street 1:12000 TURNMEYER DR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-3358
Practice Address - Country:US
Practice Address - Phone:256-881-6717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA1124225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant