Provider Demographics
NPI:1841594751
Name:SHOOK, BENJAMIN A (DPT)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:A
Last Name:SHOOK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 43085
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3085
Mailing Address - Country:US
Mailing Address - Phone:520-321-0204
Mailing Address - Fax:186-628-1951
Practice Address - Street 1:3945 E PARADISE FALLS DR
Practice Address - Street 2:#109
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6683
Practice Address - Country:US
Practice Address - Phone:520-321-0204
Practice Address - Fax:186-628-1951
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ9210Other