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General NPI Number Information
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NPI Number | 1114678232
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Entity Type | Individual
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Provider Name | JOSTON BENTON PT, DPT, MS
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Gender | Male
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Dates
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Enumeration Date | 01/11/2022
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Last Update Date | 09/16/2023
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Provider Practice Location Address
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Address Line | 1101 15TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20005-5002
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Country | US
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Telephone | 301-531-4741
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Fax |
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Provider Business Mailing Address
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Address Line | 712 H ST NE STE 2512
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City | WASHINGTON
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State | DC
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Zip | 20002-3627
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Country | US
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Telephone | 301-531-4741
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 28823
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT210002176
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License Number State | DC
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