MEDICARE: BENJAMIN TIMOTHY STECKER

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	5377	NM
2	225100000X	Physical Therapist	60910273	WA
3	225100000X	Physical Therapist	1276107	TX
4	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0	OTHER		N/A

General Provider Information

NPI Number	:	1811468473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN TIMOTHY STECKER

Provider Business Mailing Address
First Line	:	900 MATISSE DR APT 3046
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2481
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 MATISSE DR APT 3046
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2481
Country	:	US
Telephone Number	:	563-370-4425
Fax Number	:

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

Provider Enumeration Date	:	12/07/2018
Last Update Date	:	12/11/2018

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