Provider Demographics
NPI:1023447182
Name:PAUL, BENJAMIN R (DPT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:R
Last Name:PAUL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803
Mailing Address - Country:US
Mailing Address - Phone:814-865-3566
Mailing Address - Fax:814-235-2492
Practice Address - Street 1:143 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 112
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803
Practice Address - Country:US
Practice Address - Phone:814-865-3566
Practice Address - Fax:814-235-2492
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist