Provider Demographics
NPI:1114751500
Name:MCCANN, BENTON (DPT)
Entity type:Individual
Prefix:
First Name:BENTON
Middle Name:
Last Name:MCCANN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 S 141ST CT APT 17
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2369
Mailing Address - Country:US
Mailing Address - Phone:785-230-7231
Mailing Address - Fax:
Practice Address - Street 1:7686 WALNUT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1717
Practice Address - Country:US
Practice Address - Phone:402-819-8477
Practice Address - Fax:855-670-1789
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist