Provider Demographics
NPI:1215289087
Name:HOOPER, BENJAMIN DAVID (MS, LAT, ATC, OTC)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:DAVID
Last Name:HOOPER
Suffix:
Gender:M
Credentials:MS, LAT, ATC, OTC
Other - Prefix:
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Mailing Address - Street 1:2901 ACME BRICK PLZ
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4124
Mailing Address - Country:US
Mailing Address - Phone:817-565-6596
Mailing Address - Fax:817-529-1910
Practice Address - Street 1:305 REGENCY PKWY STE 405
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5169
Practice Address - Country:US
Practice Address - Phone:817-968-5806
Practice Address - Fax:915-703-7745
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2023-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX20000100002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer