Provider Demographics
NPI:1134505969
Name:GAYLORD, BENJAMIN (PT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:GAYLORD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 S POTOMAC ST
Mailing Address - Street 2:#400
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4536
Mailing Address - Country:US
Mailing Address - Phone:303-695-6060
Mailing Address - Fax:
Practice Address - Street 1:1411 S POTOMAC ST
Practice Address - Street 2:#400
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4536
Practice Address - Country:US
Practice Address - Phone:303-695-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist