Provider Demographics
NPI:1114681442
Name:GILLMING, BENJAMIN A (BS, PTA)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:A
Last Name:GILLMING
Suffix:
Gender:M
Credentials:BS, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 EAST 56TH ST.
Mailing Address - Street 2:STE. A
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8628
Mailing Address - Country:US
Mailing Address - Phone:308-233-5060
Mailing Address - Fax:308-233-5062
Practice Address - Street 1:920 EAST 56TH ST.
Practice Address - Street 2:STE. A
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8628
Practice Address - Country:US
Practice Address - Phone:308-233-5060
Practice Address - Fax:308-233-5062
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist