Provider Demographics
NPI:1386729556
Name:ROBINSON, BENJAMIN RAY (PT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:RAY
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 E 1000 N STE A
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1850
Mailing Address - Country:US
Mailing Address - Phone:435-896-6653
Mailing Address - Fax:435-896-6662
Practice Address - Street 1:80 E 1000 N STE A
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1850
Practice Address - Country:US
Practice Address - Phone:435-896-6653
Practice Address - Fax:435-896-6662
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6234806-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist