Provider Demographics
NPI:1366517724
Name:BENSON, ELISHA ANN (DPT)
Entity type:Individual
Prefix:MRS
First Name:ELISHA
Middle Name:ANN
Last Name:BENSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ELISHA
Other - Middle Name:ANN
Other - Last Name:VACULIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11034 CAMINO PLAYA CARMEL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124
Mailing Address - Country:US
Mailing Address - Phone:909-239-4844
Mailing Address - Fax:
Practice Address - Street 1:3450 BONITA ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910
Practice Address - Country:US
Practice Address - Phone:619-425-1084
Practice Address - Fax:619-425-1858
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist