Provider Demographics
NPI:1649633561
Name:SACKS, BENJAMIN (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:SACKS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 LISMORE AVE # 1
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4010
Mailing Address - Country:US
Mailing Address - Phone:610-563-1598
Mailing Address - Fax:
Practice Address - Street 1:105 LISMORE AVE # 1
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4010
Practice Address - Country:US
Practice Address - Phone:610-563-1598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist