Individual
BENJAMIN WAKEFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, PT
Contact information
Practice address
1510 S RIORDAN RANCH ST, FLAGSTAFF, AZ 86001-6372
(928) 214-7303
Mailing address
1510 S RIORDAN RANCH ST, FLAGSTAFF, AZ 86001-6372
(928) 214-7303
(928) 214-0696
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
LPT-31115
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001418
—
AZ
Enumeration date
01/30/2020
Last updated
05/11/2021
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