Provider Demographics
NPI:1912183674
Name:STREET, SCOTT BENSON (DAT, LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:BENSON
Last Name:STREET
Suffix:
Gender:M
Credentials:DAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:OH
Mailing Address - Zip Code:45674-3131
Mailing Address - Country:US
Mailing Address - Phone:740-245-7112
Mailing Address - Fax:
Practice Address - Street 1:218 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:OH
Practice Address - Zip Code:45674-3131
Practice Address - Country:US
Practice Address - Phone:740-245-7112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-12
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0040782255A2300X
WVAT0011292255A2300X
OHAT0023752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer