Healthcare Provider Details

I. General information

NPI: 1740154343
Provider Name (Legal Business Name): BENJAMIN WILLIAMS LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 3 MILE RD NW STE 3
GRAND RAPIDS MI
49544-8220
US

IV. Provider business mailing address

1971 E BELTLINE AVE NE STE 106
GRAND RAPIDS MI
49525-7045
US

V. Phone/Fax

Practice location:
  • Phone: 616-217-3646
  • Fax:
Mailing address:
  • Phone: 616-217-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501016970
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: