Provider Demographics
NPI:1689104630
Name:RICE, BEN
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:RICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 140
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-0140
Mailing Address - Country:US
Mailing Address - Phone:618-724-7456
Mailing Address - Fax:618-724-7492
Practice Address - Street 1:7703 GRAMMER HILL RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812-4596
Practice Address - Country:US
Practice Address - Phone:618-724-7456
Practice Address - Fax:618-724-7492
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant