Provider Demographics
NPI:1285086876
Name:MILLER, BENJAMIN (PT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:MILLER
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 1:59 SPRINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-4340
Mailing Address - Country:US
Mailing Address - Phone:412-956-6966
Mailing Address - Fax:
Practice Address - Street 1:59 SPRINGDALE AVE
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-4340
Practice Address - Country:US
Practice Address - Phone:412-956-6966
Practice Address - Fax:508-804-7175
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT03366225100000X
CA40564225100000X
MA25149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist