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NPI Code Detail

MEDICARE: BENJAMIN DIEHL

MEDICARE: BENJAMIN DIEHL
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 Therapist

General Provider Information

NPI Number : 1568028694
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN DIEHL
Provider Business Mailing Address
First Line : 1200 CORPORATE DR STE 400
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35242-5424
Country : US
Telephone Number : 423-682-8840
Fax Number : 423-602-2028
Provider Business Practice Location Address
First Line : 5619 CAROLINA BEACH RD STE 120
Second Line :
City : WILMINGTON
State : NC
Zip : 28412-2815
Country : US
Telephone Number : 910-790-1976
Fax Number : 910-790-1978
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2019
Last Update Date : 05/14/2019

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