Provider Demographics
NPI:1699715615
Name:BENJAMIN, DANIEL P (PT)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:BENJAMIN
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:1100 JOLIET ST
Practice Address - Street 2:SUITE 205
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1996
Practice Address - Country:US
Practice Address - Phone:219-864-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008615A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01062367OtherMEDICARE RAILROAD
IN000000363564OtherANTHEM - APT PLUS
IN000000363578OtherANTHEM - 1ST AID PLUS
IN000000363579OtherANTHEM - MBWOUDE
INP00259764Medicare ID - Type UnspecifiedRR MEDICARE
IN000000363564OtherANTHEM - APT PLUS
IN214690QMedicare ID - Type UnspecifiedPART B GROUP MEMBER
IN214710OMedicare ID - Type UnspecifiedPART B GROUP MEMBER
INM400052232Medicare PIN