=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487569059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTORIA H BENSON PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2026
-----------------------------------------------------
Last Update Date | 08/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 402 RED RIVER AVE N STE 6
-----------------------------------------------------
City | COLD SPRING
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56320-1523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-685-7269
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19946 BEAVER LAKE RD
-----------------------------------------------------
City | SAINT AUGUSTA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55353-9712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-292-4872
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | A3186
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------