Provider Demographics
NPI:1982720447
Name:MCCLUSKE, BENJAMIN THOMAS (AP , LMT)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:THOMAS
Last Name:MCCLUSKE
Suffix:
Gender:M
Credentials:AP , LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 LAUREL RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-1719
Mailing Address - Country:US
Mailing Address - Phone:407-672-0912
Mailing Address - Fax:
Practice Address - Street 1:1080 S DILLARD ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3914
Practice Address - Country:US
Practice Address - Phone:407-672-0912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2320171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist