Healthcare Provider Details

I. General information

NPI: 1568293777
Provider Name (Legal Business Name): BENJAMIN ZOOK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 CHEYENNE BLVD STE N
COLORADO SPRINGS CO
80905-2522
US

IV. Provider business mailing address

202 CHEYENNE BLVD
COLORADO SPRINGS CO
80905-2522
US

V. Phone/Fax

Practice location:
  • Phone: 719-527-9331
  • Fax: 719-527-9372
Mailing address:
  • Phone: 719-527-9331
  • Fax: 719-527-9372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL0020029
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: