Provider Demographics
NPI:1114125655
Name:ANDERSON, BENJAMIN EDWARD (PT)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:EDWARD
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CRAWFORD DR SE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-0216
Mailing Address - Country:US
Mailing Address - Phone:423-504-0132
Mailing Address - Fax:423-570-8001
Practice Address - Street 1:7937 RHEA COUNTY HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5990
Practice Address - Country:US
Practice Address - Phone:423-570-0800
Practice Address - Fax:423-570-8001
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist