Provider Demographics
NPI:1366940892
Name:ANTHONY, BENJAMIN JAMES (ATC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JAMES
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2978 COUNTY ROAD 14
Mailing Address - Street 2:
Mailing Address - City:FRIONA
Mailing Address - State:TX
Mailing Address - Zip Code:79035-7008
Mailing Address - Country:US
Mailing Address - Phone:806-265-5583
Mailing Address - Fax:
Practice Address - Street 1:2978 COUNTY ROAD 14
Practice Address - Street 2:
Practice Address - City:FRIONA
Practice Address - State:TX
Practice Address - Zip Code:79035-7008
Practice Address - Country:US
Practice Address - Phone:806-265-5583
Practice Address - Fax:806-265-5583
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty