Provider Demographics
NPI:1740154343
Name:WILLIAMS, BENJAMIN (LMT)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 E BELTLINE AVE NE STE 106
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7045
Mailing Address - Country:US
Mailing Address - Phone:616-217-3646
Mailing Address - Fax:
Practice Address - Street 1:700 3 MILE RD NW STE 3
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8220
Practice Address - Country:US
Practice Address - Phone:616-217-3646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501016970225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist