Provider Demographics
NPI:1033356639
Name:LEUBITZ, BENJAMIN (OTR)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:LEUBITZ
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4081 N 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1926
Mailing Address - Country:US
Mailing Address - Phone:954-243-7745
Mailing Address - Fax:
Practice Address - Street 1:4081 N 37TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1926
Practice Address - Country:US
Practice Address - Phone:954-243-7745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 12605225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT12605OtherSTATE OF FLORIDA