Provider Demographics
NPI:1760828917
Name:MENKE, BENJAMIN T (DPT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:T
Last Name:MENKE
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 1:13740 W STATE HIGHWAY 29 STE 3
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-6283
Mailing Address - Country:US
Mailing Address - Phone:512-778-6700
Mailing Address - Fax:512-778-6121
Practice Address - Street 1:17325 BELL NORTH DR STE 2B
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-3470
Practice Address - Country:US
Practice Address - Phone:888-590-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1230031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist