Provider Demographics
NPI:1740720572
Name:COLLETTI, BENJAMIN (DAT, LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:COLLETTI
Suffix:
Gender:M
Credentials:DAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7628 APPLETREE LN
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2437
Mailing Address - Country:US
Mailing Address - Phone:630-862-5060
Mailing Address - Fax:
Practice Address - Street 1:7628 APPLETREE LN
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-2437
Practice Address - Country:US
Practice Address - Phone:630-862-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
IL096.0054012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program