Provider Demographics
NPI:1619166576
Name:WARREN, BENJAMIN PATRICK (PT)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:PATRICK
Last Name:WARREN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 LAKE PARK RD APT 2103
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1339
Mailing Address - Country:US
Mailing Address - Phone:859-967-6866
Mailing Address - Fax:
Practice Address - Street 1:155 W TIVERTON WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-4418
Practice Address - Country:US
Practice Address - Phone:859-272-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004967225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist