Provider Demographics
NPI:1659972495
Name:MITCHELL, BENJAMIN JOHN (PT, DPT, CWS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JOHN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PT, DPT, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1862 JENTIF CT NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-1990
Mailing Address - Country:US
Mailing Address - Phone:503-798-2802
Mailing Address - Fax:
Practice Address - Street 1:2608 CASCADIA INDUSTRIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1372
Practice Address - Country:US
Practice Address - Phone:503-371-4567
Practice Address - Fax:503-371-4569
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR05975225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist