Provider Demographics
NPI:1154032753
Name:CARRIE B. BENTON, LLC
Entity type:Organization
Organization Name:CARRIE B. BENTON, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:BESS
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:803-943-3914
Mailing Address - Street 1:103 3RD ST E
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:SC
Mailing Address - Zip Code:29924-2511
Mailing Address - Country:US
Mailing Address - Phone:803-943-3914
Mailing Address - Fax:803-943-5131
Practice Address - Street 1:103 THIRD STREET
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:SC
Practice Address - Zip Code:29924
Practice Address - Country:US
Practice Address - Phone:803-943-3914
Practice Address - Fax:803-943-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty