Provider Demographics
NPI:1225324478
Name:HOPKINS, BENJAMIN TYLER (PT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:TYLER
Last Name:HOPKINS
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 1:412 MALCOLM DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6115
Mailing Address - Country:US
Mailing Address - Phone:443-605-0505
Mailing Address - Fax:443-605-0506
Practice Address - Street 1:412 MALCOLM DR
Practice Address - Street 2:SUITE 310
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6115
Practice Address - Country:US
Practice Address - Phone:443-605-0505
Practice Address - Fax:443-605-0506
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207748225100000X
MD23672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist