Provider Demographics
NPI:1528511094
Name:BENSON, KIRSTEN BOMBARDIER
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:BOMBARDIER
Last Name:BENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:LEIGH
Other - Last Name:BOMBARDIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:185 OCEAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3600
Mailing Address - Country:US
Mailing Address - Phone:207-799-8226
Mailing Address - Fax:207-799-9340
Practice Address - Street 1:22 DOGWOOD LN
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1170
Practice Address - Country:US
Practice Address - Phone:207-272-8341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4725225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist