Provider Demographics
NPI:1730520891
Name:BENTON, RONALD MAX (ATC)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:MAX
Last Name:BENTON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36511 SCOTTSMOUR CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-3461
Mailing Address - Country:US
Mailing Address - Phone:216-299-4473
Mailing Address - Fax:
Practice Address - Street 1:36511 SCOTTSMOUR CT
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-3461
Practice Address - Country:US
Practice Address - Phone:216-299-4473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-19852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer