Provider Demographics
NPI:1780084137
Name:DIERINGER, BENJAMIN M (PT,DPT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:M
Last Name:DIERINGER
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:9127 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4887
Practice Address - Country:US
Practice Address - Phone:623-322-0654
Practice Address - Fax:623-322-0664
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11040PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist