Healthcare Provider Details

I. General information

NPI: 1083772388
Provider Name (Legal Business Name): BENJAMIN BENJAMIN WOBKER MS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/21/2020
Certification Date: 03/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8495 161 AVE NE
REDMOND WA
98052
US

IV. Provider business mailing address

209 KIRKLAND AVE
KIRKLAND WA
98033-6503
US

V. Phone/Fax

Practice location:
  • Phone: 425-881-3001
  • Fax: 475-881-3585
Mailing address:
  • Phone: 425-629-3502
  • Fax: 425-629-3517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00008352
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: