Provider Demographics
NPI:1245365378
Name:BENSON, ALETHA S (RPT)
Entity type:Individual
Prefix:
First Name:ALETHA
Middle Name:S
Last Name:BENSON
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1546
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93556-1546
Mailing Address - Country:US
Mailing Address - Phone:760-375-2090
Mailing Address - Fax:760-375-2090
Practice Address - Street 1:341 EAST RIDGECREST BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3984
Practice Address - Country:US
Practice Address - Phone:760-375-2090
Practice Address - Fax:760-375-2090
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist