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NPI Code Detail

MEDICARE: BENJAMIN COLLETTE PT

MEDICARE: BENJAMIN COLLETTE 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 Therapist16775-24WI
2225100000XPhysical TherapistCP050369TSC

General Provider Information

NPI Number : 1336980333
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN COLLETTE PT
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number : 800-326-2250
Fax Number :
Provider Business Practice Location Address
First Line : 1110 KEPLER DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-8306
Country : US
Telephone Number : 920-932-6005
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2024
Last Update Date : 12/12/2025

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Directions to “ BENJAMIN COLLETTE PT” Practice Location

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