Healthcare Provider Details

I. General information

NPI: 1497843577
Provider Name (Legal Business Name): BENJAMIN DAVID DUNCAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 HAVEN AVE
RANCHO CUCAMONGA CA
91730-3066
US

IV. Provider business mailing address

6282 GRETCHEN CT
FONTANA CA
92336-1039
US

V. Phone/Fax

Practice location:
  • Phone: 909-948-1124
  • Fax: 909-948-1104
Mailing address:
  • Phone: 909-948-1124
  • Fax: 909-948-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 27435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: