MEDICARE: MR. BENJAMIN SMITH

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
1	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1992165369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN SMITH

Provider Business Mailing Address
First Line	:	2635 BURNING TREE RD
Second Line	:
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08109-3676
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 NJ-73
Second Line	:
City	:	VOORHEES TOWNSHIP
State	:	NJ
Zip	:	08043
Country	:	US
Telephone Number	:	856-809-3500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/29/2016
Last Update Date	:	02/29/2016

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Directions to “ MR. BENJAMIN SMITH ” Practice Location

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