Individual
BENJAMIN FEDEWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
4341 PIEDMONT AVE STE 201, OAKLAND, CA 94611-4792
(510) 547-1630
(510) 923-1844
Mailing address
607 DEWEY AVE NW, STE 300, GRAND RAPIDS, MI 49504-5283
(616) 356-5000
(616) 356-5001
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT295677
CA
225100000X
Physical Therapist
PT60415927
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0318505
L&I
WA
01
—
0318507
L&I
WA
01
—
031853
L&I
WA
01
—
0318649
L&I
WA
Enumeration date
10/15/2013
Last updated
05/27/2021
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