1215289087 NPI number — MR. BENJAMIN DAVID HOOPER MS, LAT, ATC, OTC

Table of content: MR. BENJAMIN DAVID HOOPER MS, LAT, ATC, OTC (NPI 1215289087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215289087 NPI number — MR. BENJAMIN DAVID HOOPER MS, LAT, ATC, OTC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOOPER
Provider First Name:
BENJAMIN
Provider Middle Name:
DAVID
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, LAT, ATC, OTC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215289087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2901 ACME BRICK PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76109-4124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-565-6596
Provider Business Mailing Address Fax Number:
817-529-1910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 REGENCY PKWY STE 405
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76063-5169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-968-5806
Provider Business Practice Location Address Fax Number:
915-703-7745
Provider Enumeration Date:
10/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  2000010000 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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