MEDICARE: MR. BENJAMIN WILLIAMS LMT

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	225700000X	Massage Therapist	7501016970	MI

General Provider Information

NPI Number	:	1740154343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN WILLIAMS LMT

Provider Business Mailing Address
First Line	:	1971 E BELTLINE AVE NE STE 106
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-7045
Country	:	US
Telephone Number	:	616-217-3646
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 3 MILE RD NW STE 3
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49544-8220
Country	:	US
Telephone Number	:	616-217-3646
Fax Number	:

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

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	10/06/2025

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