Provider Demographics
NPI:1376824714
Name:BENJAMIN, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:NELSON
Mailing Address - State:PA
Mailing Address - Zip Code:16940-0033
Mailing Address - Country:US
Mailing Address - Phone:607-857-3363
Mailing Address - Fax:
Practice Address - Street 1:3805 FIELD ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-2825
Practice Address - Country:US
Practice Address - Phone:814-898-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT 017806225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist