Provider Demographics
NPI:1114954724
Name:MERRITT, BENJAMIN (ATC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:MERRITT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 FOREST LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9612
Mailing Address - Country:US
Mailing Address - Phone:803-487-0011
Mailing Address - Fax:
Practice Address - Street 1:225 MUNN RD E
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-9497
Practice Address - Country:US
Practice Address - Phone:803-548-1900
Practice Address - Fax:803-548-1911
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer