Provider Demographics
NPI:1306071691
Name:PROFITT, BENJAMIN DAVID
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DAVID
Last Name:PROFITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2091 FENTON ST
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:CO
Mailing Address - Zip Code:80214-1127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2091 FENTON ST
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:CO
Practice Address - Zip Code:80214-1127
Practice Address - Country:US
Practice Address - Phone:720-289-3861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist