Provider Demographics
NPI:1700271368
Name:SPONSLER, BEN REED (LMT, MMP)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:REED
Last Name:SPONSLER
Suffix:
Gender:M
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 NW 18TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7846
Mailing Address - Country:US
Mailing Address - Phone:515-201-8666
Mailing Address - Fax:
Practice Address - Street 1:1210 NW 18TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-7846
Practice Address - Country:US
Practice Address - Phone:515-201-8666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04372225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist