Provider Demographics
NPI:1518206028
Name:SHANABERGER, BENJAMIN SCOTT (LMT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SCOTT
Last Name:SHANABERGER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 SW 18TH TER
Mailing Address - Street 2:APT. A
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-1814
Mailing Address - Country:US
Mailing Address - Phone:305-527-5481
Mailing Address - Fax:
Practice Address - Street 1:901 PROGRESSO DR
Practice Address - Street 2:SUITE 208
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1943
Practice Address - Country:US
Practice Address - Phone:954-463-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62151172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist