Provider Demographics
NPI:1376101857
Name:HILL, BENJAMIN DALE (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DALE
Last Name:HILL
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-5612
Mailing Address - Country:US
Mailing Address - Phone:580-774-9636
Mailing Address - Fax:
Practice Address - Street 1:509 S 30TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3632
Practice Address - Country:US
Practice Address - Phone:580-323-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist