MEDICARE: DR. BENJAMIN AARON FUGITT PT, DPT, CSCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist
2	2251P0200X	Pediatric Physical Therapist	4827	NE
3	2251S0007X	Sports Physical Therapist	4827	NE
4	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1275429086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN AARON FUGITT PT, DPT, CSCS

Provider Business Mailing Address
First Line	:	111 S 38TH ST APT 240
Second Line	:
City	:	COUNCIL BLUFFS
State	:	IA
Zip	:	51501-3387
Country	:	US
Telephone Number	:	417-425-0313
Fax Number	:

Provider Business Practice Location Address
First Line	:	20502 ROOSEVELT ST
Second Line	:
City	:	ELKHORN
State	:	NE
Zip	:	68022-4148
Country	:	US
Telephone Number	:	402-955-8181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2025
Last Update Date	:	03/16/2026

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