Provider Demographics
NPI:1710282280
Name:ALWELL, BENJAMIN (PT)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:ALWELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SPERTI DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-9654
Mailing Address - Country:US
Mailing Address - Phone:859-344-9322
Mailing Address - Fax:859-344-1406
Practice Address - Street 1:1 SPERTI DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-9654
Practice Address - Country:US
Practice Address - Phone:859-344-9322
Practice Address - Fax:859-344-1406
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT003319174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist