Provider Demographics
NPI:1881113868
Name:BENKO, LEE (LMT)
Entity type:Individual
Prefix:MS
First Name:LEE
Middle Name:
Last Name:BENKO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 W 33RD AVE # A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-2016
Mailing Address - Country:US
Mailing Address - Phone:1907-279-0135
Mailing Address - Fax:
Practice Address - Street 1:2636 SPENARD RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2336
Practice Address - Country:US
Practice Address - Phone:190-727-9013
Practice Address - Fax:907-279-0135
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1057219225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty