Provider Demographics
NPI:1184860751
Name:PERO, BENJAMIN RICHARD (LMT, PTA)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:RICHARD
Last Name:PERO
Suffix:
Gender:M
Credentials:LMT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 HARLEM ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2654
Mailing Address - Country:US
Mailing Address - Phone:315-276-0170
Mailing Address - Fax:
Practice Address - Street 1:1687 ENGLISH RD
Practice Address - Street 2:INTEGRATED WELLNESS SYSTEMS
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-1609
Practice Address - Country:US
Practice Address - Phone:585-292-6428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-01
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27 022432225700000X
NY006353-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant