Provider Demographics
NPI:1356657258
Name:LLOYD, BENJAMIN LYLE (ATC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:LYLE
Last Name:LLOYD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 KELSEY DR
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972-9736
Mailing Address - Country:US
Mailing Address - Phone:419-708-9153
Mailing Address - Fax:
Practice Address - Street 1:49 KELSEY DR
Practice Address - Street 2:
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972-9736
Practice Address - Country:US
Practice Address - Phone:419-708-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART004840390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program