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General NPI Number Information
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NPI Number | 1275429086
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Entity Type | Individual
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Provider Name | BENJAMIN AARON FUGITT PT, DPT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 20502 ROOSEVELT ST
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City | ELKHORN
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State | NE
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Zip | 68022-4148
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Country | US
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Telephone | 402-955-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 111 S 38TH ST APT 240
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51501-3387
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Country | US
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Telephone | 417-425-0313
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 4827
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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