MEDICARE: AMY BENTON P.T

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5760	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P01322188	OTHER	OR	RR

General Provider Information

NPI Number	:	1942452537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY BENTON P.T

Provider Business Mailing Address
First Line	:	2035 NW FRONT AVE FL 2
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-2177
Country	:	US
Telephone Number	:	503-308-1332
Fax Number	:	503-850-9021

Provider Business Practice Location Address
First Line	:	2035 NW FRONT AVE FL 2
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97209-2177
Country	:	US
Telephone Number	:	503-308-1332
Fax Number	:	503-850-9021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	11/21/2024

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Directions to “ AMY BENTON P.T” Practice Location

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