Provider Demographics
NPI:1114377769
Name:HUMMEL, BENJAMIN
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:HUMMEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19964 HILLTOP RD STE B
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-6423
Mailing Address - Country:US
Mailing Address - Phone:303-840-4667
Mailing Address - Fax:303-840-4658
Practice Address - Street 1:19964 HILLTOP RD STE B
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7317
Practice Address - Country:US
Practice Address - Phone:303-840-4667
Practice Address - Fax:303-840-4658
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0014062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist