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NPI Code Detail

MEDICARE: DR. BENJAMIN R GUCK PT, ATC

MEDICARE: DR. BENJAMIN R GUCK PT, ATC
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
1225100000XPhysical Therapist8124MN

General Provider Information

NPI Number : 1598928269
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BENJAMIN R GUCK PT, ATC
Provider Business Mailing Address
First Line : 430 5TH ST N
Second Line :
City : BRECKENRIDGE
State : MN
Zip : 56520-1426
Country : US
Telephone Number : 218-641-7725
Fax Number : 218-641-6625
Provider Business Practice Location Address
First Line : 430 5TH ST N
Second Line :
City : BRECKENRIDGE
State : MN
Zip : 56520-1426
Country : US
Telephone Number : 218-641-7725
Fax Number : 218-641-6625
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2008
Last Update Date : 07/03/2008

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