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General NPI Number Information
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NPI Number | 1356740468
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Entity Type | Individual
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Provider Name | BENJAMIN ROCKWELL ATC
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Gender | Male
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 03/01/2021
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Provider Practice Location Address
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Address Line | 1502 TAFT AVE
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City | EAU CLAIRE
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State | WI
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Zip | 54701-6666
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Country | US
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Telephone | 715-240-0611
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Fax |
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Provider Business Mailing Address
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Address Line | 3825 ROBERT PL
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City | STEVENS POINT
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State | WI
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Zip | 54481-2384
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1201-39
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License Number State | WI
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