Individual provider Active NPI

Benjamin J Holzman, MPT,LAT

  • Physical Therapist
  • New Berlin, WI
National Provider Identifier
1457522542
Registry record updated Jul 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
10942-24 Issued in WI
Practice address
15312 W Beloit Rd
New Berlin, WI 53151-7447
Phone
(262) 641-5771
Fax
(262) 641-6317
NPI assigned
Mar 17, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 10942-24 WI Primary
Athletic Trainer 2255A2300X 734-39 WI

Addresses

Primary practice location

15312 W Beloit Rd
New Berlin, WI 53151-7447

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223

Other identifiers 1

IdentifierTypeStateIssuer
1457522542MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
734-39WIMDAthletic Trainer

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406160000000",
    "number": "1457522542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223",
            "fax_number": "630-759-3251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15312 W BELOIT RD",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531517447",
            "telephone_number": "262-641-5771",
            "fax_number": "262-641-6317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLZMAN",
        "first_name": "BENJAMIN",
        "middle_name": "J",
        "credential": "MPT,LAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-17",
        "last_updated": "2014-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "10942-24",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "734-39",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457522542",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Berlin, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.