Provider Demographics
NPI:1184323149
Name:MINOR, BENJAMIN CHARLES (PT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:CHARLES
Last Name:MINOR
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 1:1001 PEACOCK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-2836
Mailing Address - Country:US
Mailing Address - Phone:765-993-2885
Mailing Address - Fax:
Practice Address - Street 1:2021 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1235
Practice Address - Country:US
Practice Address - Phone:765-983-3092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013667A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation