Individual
BENJAMIN DILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1650 MEDICAL LN, FORT MYERS, FL 33907-1116
(239) 277-9818
Mailing address
1316 SE 19TH ST, CAPE CORAL, FL 33990-4574
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA6818
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y902L
BCBS GROUP NUMBER
FL
Enumeration date
04/20/2007
Last updated
07/08/2007
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