Provider Demographics
NPI:1841341310
Name:GILBERT, BENJAMIN LEON (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LEON
Last Name:GILBERT
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4017 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3821
Mailing Address - Country:US
Mailing Address - Phone:727-686-3574
Mailing Address - Fax:
Practice Address - Street 1:4017 EVERETT ST
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-3821
Practice Address - Country:US
Practice Address - Phone:727-686-3574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14792225100000X
DCPT872233225100000X
MD26662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6987AMedicare ID - Type UnspecifiedPERFORMING PROVIDER NUMBE