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General NPI Number Information
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NPI Number | 1437925633
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Entity Type | Individual
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Provider Name | BENJAMIN BRUE PTA
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Gender | Male
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Dates
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Enumeration Date | 11/29/2023
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 6017 HILLSIDE RD
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City | AMARILLO
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State | TX
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Zip | 79109-7209
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Country | US
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Telephone | 806-680-5888
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Fax | 806-553-6248
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Provider Business Mailing Address
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Address Line | PO BOX 932184
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City | ATLANTA
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State | GA
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Zip | 31193-2184
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Country | US
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Telephone | 806-780-2329
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2179841
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License Number State | TX
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