Provider Demographics
NPI:1457702938
Name:BENTON, ANNE ROBL (LAT,ATC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:ROBL
Last Name:BENTON
Suffix:
Gender:F
Credentials:LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 FOREST HILLS RD W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3412
Mailing Address - Country:US
Mailing Address - Phone:252-243-9629
Mailing Address - Fax:252-243-0915
Practice Address - Street 1:1803 FOREST HILLS RD W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3412
Practice Address - Country:US
Practice Address - Phone:252-243-9629
Practice Address - Fax:252-243-0915
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer