Provider Demographics
NPI:1083701759
Name:SOWLES, BENJAMIN C (MPT)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:C
Last Name:SOWLES
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16147 LANCASTER HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2050
Mailing Address - Country:US
Mailing Address - Phone:704-542-8855
Mailing Address - Fax:704-542-8900
Practice Address - Street 1:16147 LANCASTER HWY
Practice Address - Street 2:SUITE 130
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2050
Practice Address - Country:US
Practice Address - Phone:704-542-8855
Practice Address - Fax:704-542-8900
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19470225100000X
NC11209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9162OtherBLUE CROSS BLUE SHIELD
FLY9162OtherBLUE CROSS BLUE SHIELD
U52402Medicare UPIN