Provider Demographics
NPI:1912310871
Name:WERTZ, BENJAMIN TOPPER III (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:TOPPER
Last Name:WERTZ
Suffix:III
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 1:1575 PEREGRINE VISTA HTS
Mailing Address - Street 2:APT#303
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-4127
Mailing Address - Country:US
Mailing Address - Phone:480-229-4430
Mailing Address - Fax:
Practice Address - Street 1:1775 S 8TH ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1926
Practice Address - Country:US
Practice Address - Phone:719-477-6870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist