Provider Demographics
NPI:1235321860
Name:BENSON, LLC, CHRISTOPHER LAVERNE (LMT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LAVERNE
Last Name:BENSON, LLC
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19 RENDE PARK
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-4515
Mailing Address - Country:US
Mailing Address - Phone:585-755-7246
Mailing Address - Fax:888-266-4849
Practice Address - Street 1:310 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-2718
Practice Address - Country:US
Practice Address - Phone:631-266-6666
Practice Address - Fax:888-266-4849
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017265225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist