Provider Demographics
NPI:1780436527
Name:BENSON, ANDREA KAMINSKI (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:KAMINSKI
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 1:22 CARRIAGE PATH N
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-7539
Mailing Address - Country:US
Mailing Address - Phone:203-258-7984
Mailing Address - Fax:
Practice Address - Street 1:13937 SPRAGUE LANE
Practice Address - Street 2:STE. 100
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020
Practice Address - Country:US
Practice Address - Phone:203-258-7984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist