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General NPI Number Information
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NPI Number | 1255667614
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Entity Type | Individual
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Provider Name | BENSON SLADE MILLER LPTA
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Gender | Male
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 2065 GRAYSON HWY STE B
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City | GRAYSON
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State | GA
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Zip | 30017-1766
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Country | US
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Telephone | 678-376-0213
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Fax |
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Provider Business Mailing Address
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Address Line | 3963 CREST LAKE DR
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City | SOUTHSIDE
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State | AL
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Zip | 35907-0549
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Country | US
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Telephone | 256-485-3637
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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 | 5101
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License Number State | AL
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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 | 21588
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License Number State | FL
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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 | 2073163
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA004224
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License Number State | GA
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