Provider Demographics
NPI:1639982283
Name:BENSON, TRACY EVANS (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:EVANS
Last Name:BENSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3874 FORT TRL NE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2081
Mailing Address - Country:US
Mailing Address - Phone:706-288-9810
Mailing Address - Fax:
Practice Address - Street 1:3175 RIVER EXCHANGE DR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-4271
Practice Address - Country:US
Practice Address - Phone:706-288-9810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT009387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist