Provider Demographics
NPI:1538728696
Name:STUCKEY, BENJAMIN (PT, DPT, COTA, CSCS)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:STUCKEY
Suffix:
Gender:M
Credentials:PT, DPT, COTA, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412307
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2307
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:680 KINGSBOROUGH SQ STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4988
Practice Address - Country:US
Practice Address - Phone:757-547-0434
Practice Address - Fax:757-547-0625
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16245-24225100000X
VACP030726T225100000X
NCP21981225100000X
MDCP021659T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist