Provider Demographics
NPI:1982330270
Name:BENSEN-EDER, JILLIAN FRANCES (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:FRANCES
Last Name:BENSEN-EDER
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 1:2900 GARDEN HILLS LOOP
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6181
Mailing Address - Country:US
Mailing Address - Phone:516-582-9722
Mailing Address - Fax:
Practice Address - Street 1:13314 GA HIGHWAY 144
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7387
Practice Address - Country:US
Practice Address - Phone:912-910-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0023192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer