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General NPI Number Information
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NPI Number | 1194197806
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Entity Type | Individual
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Provider Name | TANNER BENSON
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Gender | Male
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 36 SAUK CT
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City | SPARLAND
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State | IL
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Zip | 61565-9409
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Country | US
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Telephone | 309-371-5350
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Fax |
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Provider Business Mailing Address
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Address Line | 36 SAUK CT
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City | SPARLAND
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State | IL
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Zip | 61565-9409
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Country | US
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Telephone | 309-371-5350
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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 | PT-2024-0345
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2116126
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160006710
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070025342
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License Number State | IL
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