Individual
BENJAMIN MARK MASTBERGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5570 WILSON AVE SW STE A, WYOMING, MI 49418-8867
(616) 855-1495
(616) 855-1496
Mailing address
4761 LAKE MICHIGAN DR NW STE A, GRAND RAPIDS, MI 49534-6300
(616) 608-9978
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501018373
MI
Other
Enumeration date
08/25/2017
Last updated
07/18/2018
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