Provider Demographics
NPI:1609195916
Name:DEUTSCHMAN, BENJAMIN R (DPT)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:R
Last Name:DEUTSCHMAN
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 1:8642 F ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1639
Mailing Address - Country:US
Mailing Address - Phone:402-393-9390
Mailing Address - Fax:402-393-9388
Practice Address - Street 1:109 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:IA
Practice Address - Zip Code:51546-1335
Practice Address - Country:US
Practice Address - Phone:712-644-3456
Practice Address - Fax:402-393-9388
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004890225100000X
NE2842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025410100Medicaid
NE47082113700Medicaid
NE10025768700Medicaid
NE47082113700Medicaid