Healthcare Provider Details

I. General information

NPI: 1275429086
Provider Name (Legal Business Name): BENJAMIN AARON FUGITT PT, DPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20502 ROOSEVELT ST
ELKHORN NE
68022-4148
US

IV. Provider business mailing address

111 S 38TH ST APT 240
COUNCIL BLUFFS IA
51501-3387
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-8181
  • Fax:
Mailing address:
  • Phone: 417-425-0313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number4827
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number4827
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: