Provider Demographics
NPI:1245536754
Name:FRITSCH, BENJAMIN P (PTA)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:P
Last Name:FRITSCH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:KS
Mailing Address - Zip Code:67063-1553
Mailing Address - Country:US
Mailing Address - Phone:620-947-1425
Mailing Address - Fax:620-947-5690
Practice Address - Street 1:701 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:KS
Practice Address - Zip Code:67063-1553
Practice Address - Country:US
Practice Address - Phone:620-947-1425
Practice Address - Fax:620-947-5690
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02079225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant