Provider Demographics
NPI:1649439407
Name:BENTON, DONNA ANDREWS (PT)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:ANDREWS
Last Name:BENTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:GA
Mailing Address - Zip Code:31087
Mailing Address - Country:US
Mailing Address - Phone:706-444-9200
Mailing Address - Fax:706-444-9201
Practice Address - Street 1:446 SPRING STREET
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:GA
Practice Address - Zip Code:31087
Practice Address - Country:US
Practice Address - Phone:706-444-9200
Practice Address - Fax:706-444-9201
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA000823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist