Provider Demographics
NPI:1235653650
Name:HANNULA, BENJAMIN LEE (DPT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LEE
Last Name:HANNULA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N TACOMA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-3131
Mailing Address - Country:US
Mailing Address - Phone:253-274-1884
Mailing Address - Fax:253-274-1885
Practice Address - Street 1:1 N TACOMA AVE STE 103
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3131
Practice Address - Country:US
Practice Address - Phone:253-274-1884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist