Provider Demographics
NPI:1386258341
Name:STEFKA, BENJAMIN T (ATC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:T
Last Name:STEFKA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9936 GESSNER DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5085
Mailing Address - Country:US
Mailing Address - Phone:469-766-5876
Mailing Address - Fax:
Practice Address - Street 1:9936 GESSNER DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5085
Practice Address - Country:US
Practice Address - Phone:469-766-5876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBOC1982252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer