Provider Demographics
NPI:1538296835
Name:BENJAMIN, BRIAN W (DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 MIDPOINT DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4323
Mailing Address - Country:US
Mailing Address - Phone:970-224-4141
Mailing Address - Fax:970-797-1227
Practice Address - Street 1:2108 MIDPOINT DR
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4323
Practice Address - Country:US
Practice Address - Phone:970-224-4141
Practice Address - Fax:970-797-1227
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7782OtherSTATE LISCENSE
COC474708Medicare PIN