Provider Demographics
NPI:1306268503
Name:GECEWICH, BENJAMIN DAVID (ATC)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:DAVID
Last Name:GECEWICH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 PATEWOOD DR
Mailing Address - Street 2:SUITE C100
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3593
Mailing Address - Country:US
Mailing Address - Phone:864-454-7422
Mailing Address - Fax:864-454-8265
Practice Address - Street 1:200 PATEWOOD DR
Practice Address - Street 2:SUITE C100
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3593
Practice Address - Country:US
Practice Address - Phone:864-454-7422
Practice Address - Fax:864-454-8265
Is Sole Proprietor?:No
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer