Provider Demographics
NPI:1255867032
Name:STEPHENSON, BENJAMIN WADE (DPT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:WADE
Last Name:STEPHENSON
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 1:90 E MAIN ST # A
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-3030
Mailing Address - Country:US
Mailing Address - Phone:828-631-3009
Mailing Address - Fax:828-354-0209
Practice Address - Street 1:270 N HAYWOOD ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3748
Practice Address - Country:US
Practice Address - Phone:828-550-3923
Practice Address - Fax:828-354-0209
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist