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General NPI Number Information
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NPI Number | 1538728696
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Entity Type | Individual
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Provider Name | BENJAMIN STUCKEY PT, DPT, COTA, CSCS
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Gender | Male
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 680 KINGSBOROUGH SQ STE B
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4988
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Country | US
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Telephone | 757-547-0434
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Fax | 757-547-0625
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Provider Business Mailing Address
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Address Line | PO BOX 412307
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City | BOSTON
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State | MA
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Zip | 02241-2307
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Country | US
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Telephone | 914-294-4050
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Fax | 631-760-8306
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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 | 16245-24
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP030726T
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License Number State | VA
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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 | P21981
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License Number State | NC
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