Healthcare Provider Details

I. General information

NPI: 1164386405
Provider Name (Legal Business Name): BENJAMIN BERDAL DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 1ST ST
MORRIS MN
56267-1408
US

IV. Provider business mailing address

109 S OREGON AVE
MORRIS MN
56267-1513
US

V. Phone/Fax

Practice location:
  • Phone: 320-589-7658
  • Fax:
Mailing address:
  • Phone: 623-249-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13903
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: