Provider Demographics
NPI:1902598162
Name:COCKFIELD, BENJAMIN ALDEN (DPT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ALDEN
Last Name:COCKFIELD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 S WEST BAY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682-9498
Mailing Address - Country:US
Mailing Address - Phone:231-271-0375
Mailing Address - Fax:
Practice Address - Street 1:1381 S WEST BAY SHORE DR
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682-9498
Practice Address - Country:US
Practice Address - Phone:231-271-0375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501302487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist