Provider Demographics
NPI:1477170603
Name:TATE, BENJAMIN JR (MS, ATC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:TATE
Suffix:JR
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 ANDOVER RD APT C
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-1394
Mailing Address - Country:US
Mailing Address - Phone:814-823-2482
Mailing Address - Fax:
Practice Address - Street 1:100 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1100
Practice Address - Country:US
Practice Address - Phone:740-587-5063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-04
Last Update Date:2020-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0047922081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine