Organization
JUDY J BENTON
Active
Other names
PEDIATRIC PHYSICAL THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY J BENTON PT PCS (SOLE PROPRIETOR)
(256) 235-2524
Entity
Organization
Contact information
Practice address
1705 LEIGHTON AVE, ANNISTON, AL 36207-3832
(256) 235-2524
(256) 236-2573
Mailing address
1106 HERITAGE LN NE, JACKSONVILLE, AL 36265-1255
(256) 235-2524
(256) 236-2573
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
PTH1017
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009606590
—
AL
Enumeration date
03/06/2008
Last updated
06/17/2008
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