Basic Information
| Provider Information | |||||||||
| NPI: | 1003011461 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENSLEY | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | GAGE | ||||||||
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| Credential: | PT, MS, PCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 ELIZABETH LN | ||||||||
| Address2: | |||||||||
| City: | KITTERY POINT | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039055602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074394836 | ||||||||
| FaxNumber: | 2074394836 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 ELIZABETH LN | ||||||||
| Address2: | |||||||||
| City: | KITTERY POINT | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039055602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074394836 | ||||||||
| FaxNumber: | 2074394836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | 827 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.