Basic Information
| Provider Information | |||||||||
| NPI: | 1093298713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENSON | ||||||||
| FirstName: | AUDREY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 S POLK PL | ||||||||
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| City: | MASON CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504014803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6415296183 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 4TH ST SW | ||||||||
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| City: | MASON CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 504012800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6414287000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2018 | ||||||||
| LastUpdateDate: | 09/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 092076 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.