Provider Demographics
NPI:1295807592
Name:BENZ, LAURENCE N (DPT, ECS, OCS)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:N
Last Name:BENZ
Suffix:
Gender:M
Credentials:DPT, ECS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 S ENGLISH STATION ROAD
Mailing Address - Street 2:SUITE 218
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5275
Mailing Address - Country:US
Mailing Address - Phone:502-442-7697
Mailing Address - Fax:
Practice Address - Street 1:13201 MAGISTERIAL DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4105
Practice Address - Country:US
Practice Address - Phone:502-244-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001366174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist