Provider Demographics
NPI:1154850758
Name:WEEKS, BENJAMIN GABRIEL (ATC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:GABRIEL
Last Name:WEEKS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:GABE
Other - Middle Name:
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:7667 S ROPE KEY DR APT Q306
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-7639
Mailing Address - Country:US
Mailing Address - Phone:801-230-6902
Mailing Address - Fax:
Practice Address - Street 1:7667 S ROPE KEY DR APT Q306
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-7639
Practice Address - Country:US
Practice Address - Phone:801-230-6902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer