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NPI Code Detail

MEDICARE: BENSON SLADE MILLER LPTA

MEDICARE: BENSON SLADE MILLER LPTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant5101AL
2225200000XPhysical Therapy Assistant21588FL
3225200000XPhysical Therapy Assistant2073163TX
4225200000XPhysical Therapy AssistantPTA004224GA

General Provider Information

NPI Number : 1255667614
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENSON SLADE MILLER LPTA
Provider Business Mailing Address
First Line : 3963 CREST LAKE DR
Second Line :
City : SOUTHSIDE
State : AL
Zip : 35907-0549
Country : US
Telephone Number : 256-485-3637
Fax Number :
Provider Business Practice Location Address
First Line : 2065 GRAYSON HWY STE B
Second Line :
City : GRAYSON
State : GA
Zip : 30017-1766
Country : US
Telephone Number : 678-376-0213
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2009
Last Update Date : 06/16/2022

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Directions to “ BENSON SLADE MILLER LPTA” Practice Location

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