Provider Demographics
NPI:1811248644
Name:BENJAMIN, TERESA ANNE (PTA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANNE
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13791 ONEIDA DR.
Mailing Address - Street 2:APARTMENT G3
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446
Mailing Address - Country:US
Mailing Address - Phone:561-261-7503
Mailing Address - Fax:
Practice Address - Street 1:15200 JOG ROAD
Practice Address - Street 2:SUITE B8
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446
Practice Address - Country:US
Practice Address - Phone:561-495-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23548225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant