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General NPI Number Information
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NPI Number | 1174726129
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Entity Type | Individual
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Provider Name | GINGER LYNN BENSON PTA
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Gender | Female
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 201 WATERMERE DR
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City | SOUTHLAKE
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State | TX
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Zip | 76092-8137
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Country | US
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Telephone | 682-253-8983
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Fax |
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Provider Business Mailing Address
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Address Line | 1415 CHASE OAKS DR
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City | KELLER
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State | TX
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Zip | 76248-7208
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Country | US
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Telephone | 817-454-0735
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2062379
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License Number State | TX
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