Individual
BENTON TODD POWLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
8118 LARIAT DR, SUMMERFIELD, NC 27358-9757
(336) 772-3910
Mailing address
8118 LARIAT DR, SUMMERFIELD, NC 27358-9757
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2119080
TX
Other
Enumeration date
07/08/2016
Last updated
07/08/2016
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