Provider Demographics
NPI:1306965728
Name:BENJAMIN, ANN MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:BENJAMIN
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 1:3528 WADE AVE # 139
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-4048
Mailing Address - Country:US
Mailing Address - Phone:919-741-4384
Mailing Address - Fax:919-783-5231
Practice Address - Street 1:2418 BLUE RIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6480
Practice Address - Country:US
Practice Address - Phone:919-782-5954
Practice Address - Fax:919-782-6444
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2885225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5947795OtherAETNA
NC079A1OtherBC BS
NCD9500OtherMEDCOST
NC5947795OtherAETNA