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General NPI Number Information
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NPI Number | 1417666439
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Entity Type | Individual
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Provider Name | BENJAMIN THOMAS BLEESS
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Gender | Male
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Dates
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Enumeration Date | 11/17/2022
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 608 EMILY AVE NW
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City | WARROAD
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State | MN
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Zip | 56763-2706
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Country | US
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Telephone | 218-242-4633
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Fax |
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Provider Business Mailing Address
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Address Line | 63659 COUNTY ROAD 2
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City | ROOSEVELT
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State | MN
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Zip | 56673-3246
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Country | US
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Telephone | 218-242-4633
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 7400
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License Number State | MN
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