Provider Demographics
NPI:1598021941
Name:CHRISTENSEN, BENJAMIN JOHN (LMP)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JOHN
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 N CENTER PKWY
Mailing Address - Street 2:STE E
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7161
Mailing Address - Country:US
Mailing Address - Phone:509-735-1109
Mailing Address - Fax:509-735-1767
Practice Address - Street 1:1020 N CENTER PKWY
Practice Address - Street 2:STE E
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7161
Practice Address - Country:US
Practice Address - Phone:509-735-1109
Practice Address - Fax:509-735-1767
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60262967225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist