Provider Demographics
NPI:1386495943
Name:BENSON, MATTISON P (LMT)
Entity type:Individual
Prefix:
First Name:MATTISON
Middle Name:P
Last Name:BENSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6918 COUNTY ROAD 46
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-9622
Mailing Address - Country:US
Mailing Address - Phone:740-341-5702
Mailing Address - Fax:
Practice Address - Street 1:7955 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1423
Practice Address - Country:US
Practice Address - Phone:614-436-2225
Practice Address - Fax:614-436-2220
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.026811225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist