Provider Demographics
NPI:1235962648
Name:ATORRESAGASTI, BENJAMIN STEWART
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:STEWART
Last Name:ATORRESAGASTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 SW 70TH AVE.
Mailing Address - Street 2:UNIT 4
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2280 SW 70TH AVE
Practice Address - Street 2:UNIT 4
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33317
Practice Address - Country:US
Practice Address - Phone:954-300-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist