Provider Demographics
NPI:1306338074
Name:BENSON, BRADEN (DPT)
Entity type:Individual
Prefix:
First Name:BRADEN
Middle Name:
Last Name:BENSON
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:PO BOX 7132
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-7132
Mailing Address - Country:US
Mailing Address - Phone:307-682-4900
Mailing Address - Fax:
Practice Address - Street 1:1013 E BOXELDER RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5536
Practice Address - Country:US
Practice Address - Phone:307-682-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist