Healthcare Provider Details

I. General information

NPI: 1063007359
Provider Name (Legal Business Name): BENJAMIN HUFF PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 KANSAS ST APT 22
SAN DIEGO CA
92104-2917
US

IV. Provider business mailing address

3929 KANSAS ST APT 22
SAN DIEGO CA
92104-2917
US

V. Phone/Fax

Practice location:
  • Phone: 760-685-6448
  • Fax:
Mailing address:
  • Phone: 760-685-6448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number300021
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: