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NPI Code Detail

MEDICARE: BENJAMIN ALLEN DETWEILER PT

MEDICARE: BENJAMIN ALLEN DETWEILER PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT-1358ID
2225100000XPhysical TherapistPT00008570WA

General Provider Information

NPI Number : 1275738882
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN ALLEN DETWEILER PT
Provider Business Mailing Address
First Line : PO BOX 166
Second Line :
City : GRANGEVILLE
State : ID
Zip : 83530-0166
Country : US
Telephone Number : 208-983-1873
Fax Number :
Provider Business Practice Location Address
First Line : 607 W MAIN ST
Second Line :
City : GRANGEVILLE
State : ID
Zip : 83530-1345
Country : US
Telephone Number : 208-983-1700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2007
Last Update Date : 01/18/2026

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Directions to “ BENJAMIN ALLEN DETWEILER PT” Practice Location

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