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General NPI Number Information
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NPI Number | 1972013969
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Entity Type | Organization
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Legal Business Name | BENTON PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 235 FAIRBURN AVE
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City | BENTON
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State | LA
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Zip | 71006-4904
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Country | US
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Telephone | 318-935-9075
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Fax | 318-935-9076
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Provider Business Mailing Address
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Address Line | PO BOX 280
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City | STONEWALL
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State | LA
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Zip | 71078-0280
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PT/PARTNER
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Name | WILLIAM DOUGLAS JAMES
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Credential |
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Telephone | 318-935-9075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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