Healthcare Provider Details

I. General information

NPI: 1902598162
Provider Name (Legal Business Name): BENJAMIN ALDEN COCKFIELD DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 N MERIDIAN PL STE A
WASILLA AK
99654-7207
US

IV. Provider business mailing address

984 N MERIDIAN PL STE A
WASILLA AK
99654-7207
US

V. Phone/Fax

Practice location:
  • Phone: 907-631-4029
  • Fax: 907-631-4128
Mailing address:
  • Phone: 907-631-4029
  • Fax: 907-631-4128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number033956
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.PT.61668985
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number235911
License Number StateAK
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number308260
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501302487
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: