Provider Demographics
NPI:1679929566
Name:BENSON, STEPHANIE (RRT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:GAYNOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RRT
Mailing Address - Street 1:9441 LBJ FWY
Mailing Address - Street 2:SUTIE 602
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9441 LBJ FWY
Practice Address - Street 2:SUTIE 602
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4545
Practice Address - Country:US
Practice Address - Phone:469-249-1883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT 15046227900000X
MI4401004175227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered