MEDICARE: DR. BENJAMIN BAGGE PT, DPT

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	225100000X	Physical Therapist	091982	IA

General Provider Information

NPI Number	:	1285116426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN BAGGE PT, DPT

Provider Business Mailing Address
First Line	:	1706 KEOKUK AVE
Second Line	:
City	:	INDEPENDENCE
State	:	IA
Zip	:	50644-9227
Country	:	US
Telephone Number	:	319-327-1332
Fax Number	:

Provider Business Practice Location Address
First Line	:	1706 KEOKUK AVE
Second Line	:
City	:	INDEPENDENCE
State	:	IA
Zip	:	50644-9227
Country	:	US
Telephone Number	:	319-327-1332
Fax Number	:

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

Provider Enumeration Date	:	09/04/2018
Last Update Date	:	01/14/2019

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