Provider Demographics
NPI:1619205127
Name:STEWART, BENJAMIN CHARLES (DPT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:CHARLES
Last Name:STEWART
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 1:4105 BRIARGATE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3487
Mailing Address - Country:US
Mailing Address - Phone:719-368-6848
Mailing Address - Fax:
Practice Address - Street 1:2821 EAST PROSPECT RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-9213
Practice Address - Country:US
Practice Address - Phone:717-840-1874
Practice Address - Fax:717-840-0968
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020285225100000X
CO0013587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist