Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 05013330A | IN |
NPI | 1053977355 |
---|---|
Provider Name | Dr. Benjamin Scott England |
First Address | Fort Wayne, IN 46845-8666 |
Second Address | Fort Wayne, IN 46845-8870 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2019 |
Last Update Date | 13/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05013330A | PT LICENSE (01) | IN |