Healthcare Provider Details

I. General information

NPI: 1578152567
Provider Name (Legal Business Name): BEN JOSEPH MAREAN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WARREN ST
EUGENE OR
97405-1116
US

IV. Provider business mailing address

2300 WARREN ST
EUGENE OR
97405-1116
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8778
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: