Provider Demographics
NPI:1285116426
Name:BAGGE, BENJAMIN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:BAGGE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 KEOKUK AVE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-9227
Mailing Address - Country:US
Mailing Address - Phone:319-327-1332
Mailing Address - Fax:
Practice Address - Street 1:1706 KEOKUK AVE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-9227
Practice Address - Country:US
Practice Address - Phone:319-327-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist