Healthcare Provider Details

I. General information

NPI: 1053237123
Provider Name (Legal Business Name): BENJAMIN STANFORD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 N 5TH AVE
SEQUIM WA
98382-3079
US

IV. Provider business mailing address

1905 SE 192ND AVE STE 109
CAMAS WA
98607-7415
US

V. Phone/Fax

Practice location:
  • Phone: 360-683-0632
  • Fax: 360-681-5483
Mailing address:
  • Phone: 360-210-5440
  • Fax: 360-210-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.PT.70131704
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: