Provider Demographics
NPI:1356392849
Name:DEWAARD, BENJAMIN PAUL (MSPT)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:PAUL
Last Name:DEWAARD
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 N 86TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-3718
Mailing Address - Country:US
Mailing Address - Phone:402-484-7117
Mailing Address - Fax:402-484-7118
Practice Address - Street 1:4920 N 26TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4748
Practice Address - Country:US
Practice Address - Phone:402-434-5361
Practice Address - Fax:402-434-5365
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22522251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE280772Medicare ID - Type UnspecifiedNEW # EFFECTIVE 01-02-07