Provider Demographics
NPI:1629629712
Name:NEAL, BENJAMIN W (DPT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:W
Last Name:NEAL
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 1:101 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304-2426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8112 NY-12
Practice Address - Street 2:1
Practice Address - City:BARNEVELD
Practice Address - State:NY
Practice Address - Zip Code:13304
Practice Address - Country:US
Practice Address - Phone:315-896-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist