1598034308 NPI number — CAROL BENJAMIN, PT, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598034308 NPI number — CAROL BENJAMIN, PT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROL BENJAMIN, PT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1598034308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2119 WESTLAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGMONT
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80503-8102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-684-9456
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6640 GUNPARK DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BOULDER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80301-7000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-938-3770
Provider Business Practice Location Address Fax Number:
720-542-8932
Provider Enumeration Date:
12/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BENJAMIN
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
303-938-3770

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  3878 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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