Provider Demographics
NPI:1346468360
Name:KING, BENJAMIN C (LMP)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:C
Last Name:KING
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:HANDS OF HOPE
Other - Middle Name:
Other - Last Name:MASSAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:83068 LOWER DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MILTON FREEWATER
Mailing Address - State:OR
Mailing Address - Zip Code:97862-7328
Mailing Address - Country:US
Mailing Address - Phone:509-540-7211
Mailing Address - Fax:888-972-3661
Practice Address - Street 1:800 SPRAGUE AVE
Practice Address - Street 2:SUITE #104
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3900
Practice Address - Country:US
Practice Address - Phone:509-540-7211
Practice Address - Fax:888-972-3661
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014190225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4750KIOtherPROVIDER RIDER NUMBER