Provider Demographics
NPI:1194076554
Name:BENSON, RUTH (PT)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 2ND AVE W STE 50
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5918
Mailing Address - Country:US
Mailing Address - Phone:701-774-7430
Mailing Address - Fax:701-774-7465
Practice Address - Street 1:115 2ND AVE W STE 50
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5918
Practice Address - Country:US
Practice Address - Phone:701-774-7430
Practice Address - Fax:701-774-7465
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist