Provider Demographics
NPI:1891328647
Name:GAINES, BENJAMIN STOCKTON
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:STOCKTON
Last Name:GAINES
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 1:3810 E CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-5441
Mailing Address - Country:US
Mailing Address - Phone:805-748-7098
Mailing Address - Fax:
Practice Address - Street 1:13701 E SPRAGUE AVE STE B417W1
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0811
Practice Address - Country:US
Practice Address - Phone:509-922-5585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA06993393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist