Individual
CHARLES A BENFORD SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
5888 RIDGEWOOD RD, SUITE B, JACKSON, MS 39211-2644
(601) 978-1798
(601) 978-1799
Mailing address
5888 RIDGEWOOD RD, SUITE B, JACKSON, MS 39211-2644
(601) 978-1798
(601) 978-1799
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT0223
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05855578
—
MS
01
—
640830003
TAX ID
MS
Enumeration date
03/08/2007
Last updated
11/13/2017
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