MEDICARE: MR. BENJAMIN G SLOCUM 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	5501021553	MI

General Provider Information

NPI Number	:	1982355202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN G SLOCUM PT, DPT

Provider Business Mailing Address
First Line	:	24014 W RENWICK RD STE F
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60544-8708
Country	:	US
Telephone Number	:	800-974-4378
Fax Number	:	630-515-1536

Provider Business Practice Location Address
First Line	:	5316 E PICKARD ST STE C
Second Line	:
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-1145
Country	:	US
Telephone Number	:	800-974-4378
Fax Number	:	630-515-1536

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

Provider Enumeration Date	:	01/18/2022
Last Update Date	:	01/18/2022

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