Provider Demographics
NPI:1992058754
Name:SEITZ, BENJAMIN WILLIAM (DPT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:WILLIAM
Last Name:SEITZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 FREEBOARD LN
Mailing Address - Street 2:
Mailing Address - City:CAROLINA SHORES
Mailing Address - State:NC
Mailing Address - Zip Code:28467-2440
Mailing Address - Country:US
Mailing Address - Phone:814-341-6591
Mailing Address - Fax:
Practice Address - Street 1:690 SUNSET BLVD N STE 108
Practice Address - Street 2:
Practice Address - City:SUNSET BEACH
Practice Address - State:NC
Practice Address - Zip Code:28468-5610
Practice Address - Country:US
Practice Address - Phone:814-341-6591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist