Provider Demographics
NPI:1649390436
Name:BASARTE, BENJI MARIE
Entity Type:Individual
Prefix:
First Name:BENJI MARIE
Middle Name:
Last Name:BASARTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740C STENTON AVE
Mailing Address - Street 2:APT 111
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3170
Mailing Address - Country:US
Mailing Address - Phone:917-582-5467
Mailing Address - Fax:
Practice Address - Street 1:7740C STENTON AVE
Practice Address - Street 2:APT 111
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3170
Practice Address - Country:US
Practice Address - Phone:917-582-5467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist